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Organization
VIVIAN MEDINA DDS PA
Active
Organization
VIVIAN MEDINA DDS PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. VIVIAN MEDINA (OWNER)
(813) 264-0286
Entity
Organization
Contact information
Practice address
3630 MADACA LN, TAMPA, FL 33618-2057
(813) 264-0286
(813) 960-4667
Mailing address
3630 MADACA LN, TAMPA, FL 33618-2057
(813) 264-0286
(813) 960-4667
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN12750
FL
Other
Enumeration date
08/27/2012
Last updated
08/27/2012
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