Basic Information
| Provider Information | |||||||||
| NPI: | 1316005804 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | VIETH | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DDS | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 210 INTERSTATE NORTH PKWY SE STE 300 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303392233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789169000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 210 INTERSTATE NORTH PKWY SE STE 300 | ||||||||
| Address2: | |||||||||
| City: | ATLANTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 303392233 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6789169000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/05/2006 | ||||||||
| LastUpdateDate: | 11/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | 14151 | MD | N | Dental Providers | Dentist | General Practice | 1223G0001X | 10002 | CT | N | Dental Providers | Dentist | General Practice | 1223G0001X | 2901022850 | MI | N | Dental Providers | Dentist | General Practice | 1223G0001X | 6021 | LA | N | Dental Providers | Dentist | General Practice | 1223G0001X | 4288 | SC | N | Dental Providers | Dentist | General Practice | 1223G0001X | DN21794 | MA | N | Dental Providers | Dentist | General Practice | 1223G0001X | 12010958A | IN | N | Dental Providers | Dentist | General Practice | 1223G0001X | 8559 | KY | N | Dental Providers | Dentist | General Practice | 122300000X | 035093 | NY | Y | Dental Providers | Dentist |
No ID Information.