Organization
VIVADENT PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WENDY TAVARA (OFFICE MANAGER)
(540) 663-3139
Entity
Organization
Contact information
Practice address
15521 REAL ESTATE AVE STE 200, KING GEORGE, VA 22485-5328
(540) 663-3139
(540) 301-2260
Mailing address
15521 REAL ESTATE AVE STE 200, KING GEORGE, VA 22485-5328
(540) 663-3139
(540) 301-2260
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
—
—
Other
Enumeration date
01/19/2026
Last updated
01/19/2026
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