| Vivadent PLLC | |
|
15521 Real Estate Ave Ste 200 King George VA 22485-5328 | |
| (540) 663-3139 | |
| (540) 301-2260 |
| Full Name | Vivadent PLLC |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 15521 Real Estate Ave Ste 200, King George, Virginia |
| Authorized Official Name and Position | Wendy Tavara (OFFICE MANAGER) |
| Authorized Official Contact | 5406633139 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vivadent PLLC 15521 Real Estate Ave Ste 200 King George VA 22485-5328 Ph: (540) 663-3139 | Vivadent PLLC 15521 Real Estate Ave Ste 200 King George VA 22485-5328 Ph: (540) 663-3139 |
| NPI Number | 1528927233 |
|---|---|
| Provider Enumeration Date | 01/19/2026 |
| Last Update Date | 01/19/2026 |
| Certification Date | 01/19/2026 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1528927233 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (NU) | Primary |
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