Individual
JESUS VIVAR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
11228 GEORGIA AVE STE 12, WHEATON, MD 20902-4694
(301) 929-0244
Mailing address
4207 EDMONSTON RD, BLADENSBURG, MD 20710-1230
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
18283
MD
Other
Enumeration date
03/14/2022
Last updated
01/29/2024
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