Healthcare Provider Details

I. General information

NPI: 1407930852
Provider Name (Legal Business Name): MARK W SLIVKA DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 11/08/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5311 E BROADWAY BLVD
TUCSON AZ
85711-3710
US

IV. Provider business mailing address

496 S SWEET RIDGE DR
VAIL AZ
85641-2273
US

V. Phone/Fax

Practice location:
  • Phone: 702-686-7465
  • Fax:
Mailing address:
  • Phone: 702-686-7465
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberS3-78C
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License NumberD009601
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: