Healthcare Provider Details

I. General information

NPI: 1003870908
Provider Name (Legal Business Name): NATHAN D KRIVITZKY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2006
Last Update Date: 05/27/2025
Certification Date: 05/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BRANDON RD RAF LAKENHEATH 48TH DENTAL SQUADRON
APO AE
09464-0012
US

IV. Provider business mailing address

48 MDG/RAF LAKENHEATH UNIT 5115
APO AE
09461
US

V. Phone/Fax

Practice location:
  • Phone: 210-748-7929
  • Fax:
Mailing address:
  • Phone: 314-226-8006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number2901018599
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: