Provider Demographics
NPI:1750074456
Name:SANAIOT, VIVIENNE
Entity type:Individual
Prefix:
First Name:VIVIENNE
Middle Name:
Last Name:SANAIOT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 44
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06804-0044
Mailing Address - Country:US
Mailing Address - Phone:508-596-7412
Mailing Address - Fax:
Practice Address - Street 1:26 SHORT OAK DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:CT
Practice Address - Zip Code:06804-2080
Practice Address - Country:US
Practice Address - Phone:508-596-7412
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-30
Last Update Date:2023-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT008990124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist