Provider Demographics
NPI:1124238662
Name:DANG-ROBERTS, VIVI VAN I (DDS)
Entity type:Individual
Prefix:DR
First Name:VIVI
Middle Name:VAN
Last Name:DANG-ROBERTS
Suffix:I
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:VIVI
Other - Middle Name:VAN
Other - Last Name:MCINTOSH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:526 S TONOPAH DR
Mailing Address - Street 2:STE. 200
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89106-4043
Mailing Address - Country:US
Mailing Address - Phone:702-291-2031
Mailing Address - Fax:702-366-1483
Practice Address - Street 1:2217 E LAKE MEAD BLVD
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89030-7137
Practice Address - Country:US
Practice Address - Phone:702-641-5888
Practice Address - Fax:702-633-0099
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV37161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1124238662Medicaid