Provider Demographics
NPI:1154963833
Name:SEQUEIRA, VIVIA (BDS)
Entity type:Individual
Prefix:
First Name:VIVIA
Middle Name:
Last Name:SEQUEIRA
Suffix:
Gender:F
Credentials:BDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1321 VALLEY VIEW WOODS,
Mailing Address - Street 2:VALLEY VIEW AV,
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26505
Mailing Address - Country:US
Mailing Address - Phone:304-780-4820
Mailing Address - Fax:
Practice Address - Street 1:451, WVU DENTAL CARE
Practice Address - Street 2:SUNCREST TOWNE CENTER
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-2650
Practice Address - Country:US
Practice Address - Phone:304-780-4820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-14
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVIP18011223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics