Provider Demographics
NPI:1831939651
Name:DIEP, VIVIAN (DMD)
Entity type:Individual
Prefix:
First Name:VIVIAN
Middle Name:
Last Name:DIEP
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:VIVIAN
Other - Middle Name:
Other - Last Name:DIEP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:14011 SEA MYRTLE LN
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77498-2095
Mailing Address - Country:US
Mailing Address - Phone:713-540-7289
Mailing Address - Fax:
Practice Address - Street 1:191 AZ-264
Practice Address - Street 2:
Practice Address - City:GANADO
Practice Address - State:AZ
Practice Address - Zip Code:86505
Practice Address - Country:US
Practice Address - Phone:928-755-4500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-29
Last Update Date:2024-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZD012146122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist