Active NPI
Vivian Dental
- Dental Clinic/Center
- Vivian, LA
National Provider Identifier
1235708702
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Clinic/Center
- Legal business name
- VIVIAN DENTAL
- Practice address
- 815 S Pine St
Vivian, LA 71082-3314 - Phone
- (318) 375-4001
- NPI assigned
- Jun 21, 2021
- Organization subpart
- Yes
- Parent organization
- NORTH CADDO HOSPITAL SERVICE DISTRICT
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Brent Leonard
- Title
- Financial Analyst
- Phone
- (318) 375-4099
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Clinic/Center | 261QD0000X | Primary |
Addresses
Primary practice location
815 S Pine St
Vivian, LA 71082-3314
Mailing address
PO Box 792
Vivian, LA 71082-0792
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in LA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20220318001604 | LA | Part B Supplier - Clinic/Group Practice | 8325433881 |
Receives reassigned benefits from 4 practitioners Practice locations: Vivian, LA |
National Provider Directory
National Provider Directory- Part of
- N Caddo Medical Center
Practitioners & affiliated clinicians
Practitioners 4
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1624233600000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1639612800000",
"number": "1235708702",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 792",
"city": "VIVIAN",
"state": "LA",
"postal_code": "710820792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "815 S PINE ST",
"city": "VIVIAN",
"state": "LA",
"postal_code": "710823314",
"telephone_number": "318-375-4001"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VIVIAN DENTAL",
"organizational_subpart": "YES",
"parent_organization_legal_business_name": "NORTH CADDO HOSPITAL SERVICE DISTRICT",
"enumeration_date": "2021-06-21",
"last_updated": "2021-12-16",
"certification_date": "2021-12-16",
"status": "A",
"authorized_official_last_name": "LEONARD",
"authorized_official_first_name": "BRENT",
"authorized_official_title_or_position": "FINANCIAL ANALYST",
"authorized_official_telephone_number": "318-375-4099"
},
"taxonomies": [
{
"code": "261QD0000X",
"taxonomy_group": "",
"desc": "Clinic/Center, Dental",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vivian, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.