MEDICARE: DR. NATHAN D KRIVITZKY DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2901018599	MI

General Provider Information

NPI Number	:	1003870908
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NATHAN D KRIVITZKY DDS

Provider Business Mailing Address
First Line	:	48 MDG/RAF LAKENHEATH
Second Line	:	UNIT 5115
City	:	APO
State	:	AE
Zip	:	09461
Country	:	US
Telephone Number	:	314-226-8006
Fax Number	:

Provider Business Practice Location Address
First Line	:	BRANDON RD
Second Line	:	RAF LAKENHEATH 48TH DENTAL SQUADRON
City	:	APO
State	:	AE
Zip	:	09464-0012
Country	:	US
Telephone Number	:	210-748-7929
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/17/2006
Last Update Date	:	05/27/2025

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