Most Relevant Information
Provider Data
| NPI Number: | 1003564626 |
| Provider Name: | JESUS VIVAR DMD |
| Entity Type: | Individual |
| Taxonomy Code: | 122300000X |
| Specialty: | Dentist |
| License Number: | 18283 |
Most Important Dates
| Enumeration Date: | 03/14/2022 |
| Last Updated: | 01/29/2024 |
Provider Practice Location
11228 GEORGIA AVE STE 12
WHEATON
MD
209024694
Practice Location Phone/Fax
| Phone: | 3019290244 |
| Fax: |
Provider Mailing Location
4207 EDMONSTON RD
BLADENSBURG
MD
207101230
Provider Mailing Phone/Fax
| Phone: | |
| Fax: |