Vivian Dental | |
815 S Pine St Vivian LA 71082-3314 | |
(318) 375-4001 | |
Not Available |
Full Name | Vivian Dental |
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Speciality | Clinic/Center |
Location | 815 S Pine St, Vivian, Louisiana |
Authorized Official Name and Position | Brent Leonard (FINANCIAL ANALYST) |
Authorized Official Contact | 3183754099 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Vivian Dental Po Box 792 Vivian LA 71082-0792 Ph: () - | Vivian Dental 815 S Pine St Vivian LA 71082-3314 Ph: (318) 375-4001 |
NPI Number | 1235708702 |
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Provider Enumeration Date | 06/21/2021 |
Last Update Date | 12/16/2021 |
Medicare PECOS PAC ID | 8325433881 |
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Medicare Enrollment ID | O20220318001604 |
Identifier | Type | State | Issuer |
---|---|---|---|
1235708702 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
Provider Name | Cristin Jackson |
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Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1598420788 PECOS PAC ID: 0143617605 Enrollment ID: I20220502000976 |
Provider Name | Lewis K Scott |
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Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1104820778 PECOS PAC ID: 1153633227 Enrollment ID: I20230904000229 |
Provider Name | Christopher Eric Brasseaux |
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Provider Type | Practitioner - Dentist |
Provider Identifiers | NPI Number: 1447984117 PECOS PAC ID: 7214319599 Enrollment ID: I20240801001825 |