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General NPI Number Information
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NPI Number | 1265851075
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Entity Type | Organization
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Legal Business Name | VIVA DENTAL, P.C.
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Dates
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Enumeration Date | 04/09/2014
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Last Update Date | 04/09/2014
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Provider Practice Location Address
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Address Line | 8715 37TH AVE PROFESSIONAL OFFICE A
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City | JACKSON HEIGHTS
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State | NY
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Zip | 11372-7701
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Country | US
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Telephone | 718-651-8488
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Fax |
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Provider Business Mailing Address
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Address Line | 5 WISTERIA WAY
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City | COMMACK
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State | NY
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Zip | 11725-2726
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Country | US
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Telephone | 917-692-3393
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | DR. MEGNET WON
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Credential | D.M.D
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Telephone | 917-692-3393
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 048800
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License Number State | NY
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