Healthcare Provider Details

I. General information

NPI: 1306648142
Provider Name (Legal Business Name): VIVIAN MUNIR BINYAMEEN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2025
Last Update Date: 03/31/2025
Certification Date: 03/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 ROUTE 134
SOUTH DENNIS MA
02660-3451
US

IV. Provider business mailing address

50285 MURRAY DR
MACOMB MI
48044-1338
US

V. Phone/Fax

Practice location:
  • Phone: 508-778-5400
  • Fax:
Mailing address:
  • Phone: 586-222-7194
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDL100720
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: