MEDICARE: VIVAAN DENTAL SYSTEMS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	D12203	MN

General Provider Information

NPI Number	:	1053711713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VIVAAN DENTAL SYSTEMS

Provider Business Mailing Address
First Line	:	8511 JEFFERSON LN N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-2121
Country	:	US
Telephone Number	:	763-205-0526
Fax Number	:

Provider Business Practice Location Address
First Line	:	8511 JEFFERSON LN N
Second Line	:
City	:	BROOKLYN PARK
State	:	MN
Zip	:	55445-2121
Country	:	US
Telephone Number	:	763-205-0526
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	DR. ANUPAM MUKUNDRAI GATECHA
Credential	:	BDS
Telephone Number	:	763-205-0526

Provider Enumeration Date	:	09/01/2014
Last Update Date	:	12/18/2014

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Directions to “VIVAAN DENTAL SYSTEMS ” Practice Location

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