Healthcare Provider Details

I. General information

NPI: 1063638799
Provider Name (Legal Business Name): MICHELE HATT VIGNAROLI D.D,S,
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1171 MURRIETA BLVD SUITE 200
LIVERMORE CA
94550-4143
US

IV. Provider business mailing address

58 LIVE OAK LN
DANVILLE CA
94506-2140
US

V. Phone/Fax

Practice location:
  • Phone: 925-449-6633
  • Fax:
Mailing address:
  • Phone: 925-449-6633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number36662
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: