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General NPI Number Information
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NPI Number | 1760738967
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Entity Type | Organization
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Legal Business Name | KRIVARCHKA FAMILY DENTISTRY P.C.
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 1511 W HOLLY BLVD
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City | BRANDON
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State | SD
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Zip | 57005-2658
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Country | US
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Telephone | 605-951-1084
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Fax |
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Provider Business Mailing Address
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Address Line | 7608 W GRINNELL CIR
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City | SIOUX FALLS
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State | SD
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Zip | 57106-7669
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Country | US
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Telephone | 605-951-1084
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Fax |
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Authorized Official
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Title or Position | DENTIST
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Name | DR. MATT VICTOR KRIVARCHKA
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Credential | DDS
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Telephone | 605-951-1084
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | D0911
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License Number State | SD
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