Healthcare Provider Details

I. General information

NPI: 1568682615
Provider Name (Legal Business Name): GIOVANNA A DUKCEVICH DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 CENTRAL PARK SO SUITE 8
NEW YORK NY
10019
US

IV. Provider business mailing address

200 E 69TH ST APT 12B
NEW YORK NY
10021
US

V. Phone/Fax

Practice location:
  • Phone: 212-582-1900
  • Fax: 212-707-8425
Mailing address:
  • Phone: 212-744-3391
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number0479761
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: