| Vivian Dental | |
|
815 S Pine St Vivian LA 71082-3314 | |
| (318) 375-4001 | |
| Not Available |
| Full Name | Vivian Dental |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 06/21/2021 |
| Last Update Date | 12/16/2021 |
| Medicare PECOS PAC ID | 8325433881 |
|---|---|
| Medicare Enrollment ID | O20220318001604 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1235708702 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | (* (Not Available)) | Primary |
| Provider Name | Cristin Jackson |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1598420788 PECOS PAC ID: 0143617605 Enrollment ID: I20220502000976 |
| Provider Name | Lewis K Scott |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1104820778 PECOS PAC ID: 1153633227 Enrollment ID: I20230904000229 |
| Provider Name | Christopher Eric Brasseaux |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1447984117 PECOS PAC ID: 7214319599 Enrollment ID: I20240801001825 |
| Provider Name | Anitra Michelle Craig |
|---|---|
| Provider Type | Practitioner - Dentist |
| Provider Identifiers | NPI Number: 1821136946 PECOS PAC ID: 8224548524 Enrollment ID: I20250606000745 |