Provider Demographics
NPI:1750415196
Name:ALLEN, VIVIENNE E (DDS)
Entity type:Individual
Prefix:DR
First Name:VIVIENNE
Middle Name:E
Last Name:ALLEN
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 1:26302 LA PAZ RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691
Mailing Address - Country:US
Mailing Address - Phone:949-830-4111
Mailing Address - Fax:949-830-4034
Practice Address - Street 1:26302 LA PAZ RD
Practice Address - Street 2:SUITE 106
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691
Practice Address - Country:US
Practice Address - Phone:949-830-4111
Practice Address - Fax:949-830-4034
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0332281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice