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NPI Code Detail

MEDICARE: DR. ELIZABETH ANN KIVUS D.D.S.

MEDICARE: DR. ELIZABETH ANN KIVUS 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
11223P0300XPeriodontics6222AL
21223P0300XPeriodonticsDEN4234ME

General Provider Information

NPI Number : 1801150115
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ELIZABETH ANN KIVUS D.D.S.
Provider Business Mailing Address
First Line : 1310 ALFORD AVE
Second Line :
City : HOOVER
State : AL
Zip : 35226-3199
Country : US
Telephone Number : 205-823-3461
Fax Number : 205-978-3752
Provider Business Practice Location Address
First Line : 1310 ALFORD AVE
Second Line :
City : HOOVER
State : AL
Zip : 35226-3199
Country : US
Telephone Number : 205-823-3461
Fax Number : 205-978-3752
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/02/2012
Last Update Date : 06/28/2016

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