Provider Demographics
NPI:1700103959
Name:VIVIAN'S FAMILY DENTISTRY
Entity Type:Organization
Organization Name:VIVIAN'S FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VAN
Authorized Official - Middle Name:VIVIAN
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:817-657-2818
Mailing Address - Street 1:1920 ELDORADO PKWY
Mailing Address - Street 2:SUITE 900
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069
Mailing Address - Country:US
Mailing Address - Phone:972-547-6134
Mailing Address - Fax:972-547-6136
Practice Address - Street 1:1920 ELDORADO PKWY
Practice Address - Street 2:SUITE 900
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069
Practice Address - Country:US
Practice Address - Phone:972-547-6134
Practice Address - Fax:972-547-6136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-28
Last Update Date:2014-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX229081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1285859090OtherINDIVIDUAL NPI