Provider Demographics
NPI:1801983697
Name:BOTERO-NEBEL, VIVIAN (DMD)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:
Last Name:BOTERO-NEBEL
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 SOUTH MAIN STREET
Mailing Address - Street 2:DENTAL HEALTH ASSOCIATES PA CORPORATE OFFICE 2ND FLR
Mailing Address - City:PHILLIPSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08865
Mailing Address - Country:US
Mailing Address - Phone:908-387-6120
Mailing Address - Fax:908-387-8322
Practice Address - Street 1:9 25 ALLING STREET
Practice Address - Street 2:DENTAL HEALTH ASSOCIATES PA
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07102
Practice Address - Country:US
Practice Address - Phone:973-297-1550
Practice Address - Fax:973-297-1554
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2015-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI0197321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice