Provider Demographics
NPI:1811088966
Name:VIVALDI, WALTER (DMD)
Entity type:Individual
Prefix:DR
First Name:WALTER
Middle Name:
Last Name:VIVALDI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 CALLE VICTORIA
Mailing Address - Street 2:
Mailing Address - City:ANASCO
Mailing Address - State:PR
Mailing Address - Zip Code:00610-2933
Mailing Address - Country:US
Mailing Address - Phone:787-826-7001
Mailing Address - Fax:787-826-7001
Practice Address - Street 1:32 CALLE VICTORIA
Practice Address - Street 2:
Practice Address - City:ANASCO
Practice Address - State:PR
Practice Address - Zip Code:00610-2933
Practice Address - Country:US
Practice Address - Phone:787-826-7001
Practice Address - Fax:787-826-7001
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR21541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice