| Vivid Dental Studio | |
|
301 W Bastanchury Rd Ste 5 Fullerton CA 92835-3422 | |
| (714) 871-4892 | |
| (714) 871-4896 |
| Full Name | Vivid Dental Studio |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 301 W Bastanchury Rd Ste 5, Fullerton, California |
| Authorized Official Name and Position | Tejas Shah (SECRETARY) |
| Authorized Official Contact | 7148714892 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Vivid Dental Studio 301 W Bastanchury Rd Ste 5 Fullerton CA 92835-3422 | Vivid Dental Studio 301 W Bastanchury Rd Ste 5 Fullerton CA 92835-3422 Ph: (714) 871-4892 |
| NPI Number | 1114176609 |
|---|---|
| Provider Enumeration Date | 09/09/2008 |
| Last Update Date | 09/09/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1114176609 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 34900 (California) | Primary |
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