Provider Demographics
NPI:1528290871
Name:WAICH, VIVIANA LEA (DDS)
Entity type:Individual
Prefix:DR
First Name:VIVIANA
Middle Name:LEA
Last Name:WAICH
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:16909 N BAY RD
Mailing Address - Street 2:AP 520
Mailing Address - City:SUNNY ISLES BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33160-4254
Mailing Address - Country:US
Mailing Address - Phone:305-206-9980
Mailing Address - Fax:786-284-8310
Practice Address - Street 1:782 NW 42ND AVE
Practice Address - Street 2:SUITE 538
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-5541
Practice Address - Country:US
Practice Address - Phone:305-442-8866
Practice Address - Fax:305-448-6407
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLDN187171223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice