Healthcare Provider Details

I. General information

NPI: 1699367912
Provider Name (Legal Business Name): ZIVKOVIC DENTISTRY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/08/2021
Last Update Date: 02/08/2021
Certification Date: 02/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3046 35TH ST
ASTORIA NY
11103-4702
US

IV. Provider business mailing address

3046 35TH ST
ASTORIA NY
11103-4702
US

V. Phone/Fax

Practice location:
  • Phone: 718-701-1225
  • Fax: 718-701-1265
Mailing address:
  • Phone: 718-701-1225
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JOVANKA ZIVKOVIC
Title or Position: DENTIST/OWNER
Credential:
Phone: 718-701-1225