Provider Demographics
NPI:1538021803
Name:VIVIENE VALDEZ DENTAL CORPORATION
Entity type:Organization
Organization Name:VIVIENE VALDEZ DENTAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR OF PROC DEV
Authorized Official - Prefix:
Authorized Official - First Name:AYREN
Authorized Official - Middle Name:
Authorized Official - Last Name:ENGELHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-702-1213
Mailing Address - Street 1:3075 BEACON BLVD
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3462
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13780 DOOLITTLE DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94577-5532
Practice Address - Country:US
Practice Address - Phone:510-398-0684
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-25
Last Update Date:2025-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Single Specialty