Provider Demographics
NPI:1053711713
Name:VIVAAN DENTAL SYSTEMS
Entity type:Organization
Organization Name:VIVAAN DENTAL SYSTEMS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANUPAM
Authorized Official - Middle Name:MUKUNDRAI
Authorized Official - Last Name:GATECHA
Authorized Official - Suffix:
Authorized Official - Credentials:BDS
Authorized Official - Phone:763-205-0526
Mailing Address - Street 1:8511 JEFFERSON LN N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55445-2121
Mailing Address - Country:US
Mailing Address - Phone:763-205-0526
Mailing Address - Fax:
Practice Address - Street 1:8511 JEFFERSON LN N
Practice Address - Street 2:
Practice Address - City:BROOKLYN PARK
Practice Address - State:MN
Practice Address - Zip Code:55445-2121
Practice Address - Country:US
Practice Address - Phone:763-205-0526
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-01
Last Update Date:2014-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MND12203122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty