MEDICARE: DR. VIVIENNE ESMILDA GRANT-PEART D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	28697	CA

General Provider Information

NPI Number	:	1013100411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VIVIENNE ESMILDA GRANT-PEART D.D.S.

Provider Business Mailing Address
First Line	:	6221 WILSHIRE BLVD STE 215
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-5226
Country	:	US
Telephone Number	:	323-935-1178
Fax Number	:	323-935-0577

Provider Business Practice Location Address
First Line	:	411 S LONG BEACH BLVD
Second Line	:
City	:	COMPTON
State	:	CA
Zip	:	90221-3427
Country	:	US
Telephone Number	:	310-537-2217
Fax Number	:	310-537-8062

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/20/2007
Last Update Date	:	10/24/2024

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