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NPI Code Detail

MEDICARE: DR. KRISTOFER PAUL SIVANICH D.D.S.

MEDICARE: DR. KRISTOFER PAUL SIVANICH D.D.S.
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
11223P0221XPediatric DentistryD12836MN
21223P0221XPediatric Dentistry26295TX

General Provider Information

NPI Number : 1285945089
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KRISTOFER PAUL SIVANICH D.D.S.
Provider Business Mailing Address
First Line : 36014 WRATTEN DR
Second Line : FORT HOOD DENTAC
City : FORT HOOD
State : TX
Zip : 76544
Country : US
Telephone Number : 763-670-7386
Fax Number :
Provider Business Practice Location Address
First Line : 4431 68TH ST
Second Line :
City : FORT HOOD
State : TX
Zip : 76544-5042
Country : US
Telephone Number : 254-286-7401
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2010
Last Update Date : 10/19/2016

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