Healthcare Provider Details

I. General information

NPI: 1013100411
Provider Name (Legal Business Name): VIVIENNE ESMILDA GRANT-PEART D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 S LONG BEACH BLVD
COMPTON CA
90221-3427
US

IV. Provider business mailing address

6221 WILSHIRE BLVD STE 215
LOS ANGELES CA
90048-5226
US

V. Phone/Fax

Practice location:
  • Phone: 310-537-2217
  • Fax: 310-537-8062
Mailing address:
  • Phone: 323-935-1178
  • Fax: 323-935-0577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number28697
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: