Individual
DR. VIVIANA PORTILLO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
DMD
Contact information
Practice address
370 GRAND AVE STE 200, ENGLEWOOD, NJ 07631-4109
(201) 871-3555
Mailing address
5807 MASPETH AVE FL 1, MASPETH, NY 11378-2213
(917) 650-8662
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
DN27232
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
06/17/2022
Last updated
07/21/2022
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