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General NPI Number Information
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NPI Number | 1881131415
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Entity Type | Individual
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Provider Name | MIRANDA KRIVCA DDS
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Gender | Female
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Dates
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Enumeration Date | 01/20/2017
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 2175 WANTAGH AVE
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City | WANTAGH
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State | NY
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Zip | 11793-3972
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Country | US
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Telephone | 516-409-4200
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Fax |
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Provider Business Mailing Address
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Address Line | 134 SUNKEN MEADOW RD
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City | NORTHPORT
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State | NY
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Zip | 11768-2527
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Country | US
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Telephone | 347-209-4779
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | 058600
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License Number State | NY
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