Provider Demographics
NPI:1770717480
Name:DR. VIVIEN M. MAGHIRAN DENTAL CORP
Entity type:Organization
Organization Name:DR. VIVIEN M. MAGHIRAN DENTAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIVIEN
Authorized Official - Middle Name:MATIBAS
Authorized Official - Last Name:MAGHIRAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:818-268-7790
Mailing Address - Street 1:14755 FOOTHILL BLVD
Mailing Address - Street 2:SUITE E
Mailing Address - City:FONTANA
Mailing Address - State:CA
Mailing Address - Zip Code:92335-8025
Mailing Address - Country:US
Mailing Address - Phone:909-349-1360
Mailing Address - Fax:909-349-1290
Practice Address - Street 1:14755 FOOTHILL BLVD
Practice Address - Street 2:SUITE E
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-8025
Practice Address - Country:US
Practice Address - Phone:909-349-1360
Practice Address - Fax:909-349-1290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-08
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty