Provider Demographics
NPI:1811191380
Name:VIATOR, PAUL ANTHONY (DMD)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ANTHONY
Last Name:VIATOR
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:PMB 271 BOX 10002
Mailing Address - Street 2:
Mailing Address - City:SAIPAN
Mailing Address - State:MP
Mailing Address - Zip Code:96950-8902
Mailing Address - Country:US
Mailing Address - Phone:670-788-2770
Mailing Address - Fax:
Practice Address - Street 1:HANMI BLDG MIDDLE RD
Practice Address - Street 2:NEW WAVE DENTAL CLINIC
Practice Address - City:SAIPAN
Practice Address - State:MP
Practice Address - Zip Code:96950
Practice Address - Country:US
Practice Address - Phone:670-233-3300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MP00851223G0001X
CO92461223G0001X
ORD79521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice