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General NPI Number Information
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NPI Number | 1336696426
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Entity Type | Organization
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Legal Business Name | DMITRIY PIVNIK DDS INC
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Dates
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Enumeration Date | 09/06/2016
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Last Update Date | 10/18/2022
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Provider Practice Location Address
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Address Line | 18455 TECHNOLOGY DR
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City | MORGAN HILL
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State | CA
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Zip | 95037-2822
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Country | US
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Telephone | 916-783-5239
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Fax |
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Provider Business Mailing Address
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Address Line | 18455 TECHNOLOGY DR
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City | MORGAN HILL
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State | CA
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Zip | 95037-2822
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Country | US
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Telephone | 562-577-5641
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Fax |
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Authorized Official
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Title or Position | OFFICER
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Name | DMITRIY PIVNIK
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Credential | D.D.S
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Telephone | 415-412-3158
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 100181
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License Number State | CA
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