Provider Demographics
NPI:1902144330
Name:EL PASO VIVA DENTAL
Entity Type:Organization
Organization Name:EL PASO VIVA DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHUNKIL
Authorized Official - Middle Name:
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:915-751-1007
Mailing Address - Street 1:9584 DYER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79924-4768
Mailing Address - Country:US
Mailing Address - Phone:915-751-1007
Mailing Address - Fax:915-751-1002
Practice Address - Street 1:9584 DYER ST.
Practice Address - Street 2:SUITE B
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79924
Practice Address - Country:US
Practice Address - Phone:915-751-1007
Practice Address - Fax:915-751-1002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX254831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty