Healthcare Provider Details

I. General information

NPI: 1508542762
Provider Name (Legal Business Name): VIVIAN HUYNH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2023
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

189 BAKER AVE
WEBSTER GROVES MO
63119-3732
US

IV. Provider business mailing address

189 BAKER AVE
WEBSTER GROVES MO
63119-3732
US

V. Phone/Fax

Practice location:
  • Phone: 314-961-1160
  • Fax:
Mailing address:
  • Phone: 314-968-3384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2023024877
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number28072
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: