Provider Demographics
NPI:1194059915
Name:ROKNIAN, VIVIAN A (DMD)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:A
Last Name:ROKNIAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16101 VENTURA BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2500
Mailing Address - Country:US
Mailing Address - Phone:818-380-9057
Mailing Address - Fax:
Practice Address - Street 1:16101 VENTURA BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2500
Practice Address - Country:US
Practice Address - Phone:818-380-9057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-25
Last Update Date:2009-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA58842122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist