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General NPI Number Information
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NPI Number | 1366786501
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Entity Type | Individual
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Provider Name | VICTOR AUGUSTO NIVAR DDS
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Gender | Male
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Dates
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Enumeration Date | 11/10/2012
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Last Update Date | 05/23/2019
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Provider Practice Location Address
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Address Line | 17 LIBERTY SQUARE MALL
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City | STONY POINT
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State | NY
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Zip | 10980-2400
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Country | US
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Telephone | 845-429-1293
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Fax |
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Provider Business Mailing Address
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Address Line | 809 W 177TH ST APT. # 6A
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City | NEW YORK
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State | NY
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Zip | 10033-6629
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Country | US
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Telephone | 646-745-8790
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 124Q00000X
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Taxonomy Name | Dental Hygienist
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License Number | 024128
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 060361
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License Number State | NY
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