Provider Demographics
NPI:1013100411
Name:GRANT-PEART, VIVIENNE ESMILDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:VIVIENNE
Middle Name:ESMILDA
Last Name:GRANT-PEART
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6091 W PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-2648
Mailing Address - Country:US
Mailing Address - Phone:323-935-1178
Mailing Address - Fax:323-935-0577
Practice Address - Street 1:411 S LONG BEACH BLVD
Practice Address - Street 2:
Practice Address - City:COMPTON
Practice Address - State:CA
Practice Address - Zip Code:90221-3427
Practice Address - Country:US
Practice Address - Phone:310-537-2217
Practice Address - Fax:310-537-8062
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-20
Last Update Date:2007-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA286971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice