Provider Demographics
NPI:1811917321
Name:MESINA, VIVIEN (DMD)
Entity type:Individual
Prefix:DR
First Name:VIVIEN
Middle Name:
Last Name:MESINA
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 1:3100 PRINCETON PIKE
Mailing Address - Street 2:BLDG 2
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08648-2300
Mailing Address - Country:US
Mailing Address - Phone:609-896-0589
Mailing Address - Fax:609-895-1591
Practice Address - Street 1:3100 PRINCETON PIKE
Practice Address - Street 2:BLDG 2
Practice Address - City:LAWRENCEVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08648
Practice Address - Country:US
Practice Address - Phone:609-896-0589
Practice Address - Fax:609-895-1591
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2011-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1022836001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice