Provider Demographics
NPI:1093009821
Name:KRITHARIS, VICMARY A (DMD)
Entity Type:Individual
Prefix:DR
First Name:VICMARY
Middle Name:A
Last Name:KRITHARIS
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:VICMARY
Other - Middle Name:A
Other - Last Name:MATIAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:105 ELMORA AVE
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:NJ
Mailing Address - Zip Code:07202-1614
Mailing Address - Country:US
Mailing Address - Phone:908-354-1490
Mailing Address - Fax:
Practice Address - Street 1:105 ELMORA AVE
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:NJ
Practice Address - Zip Code:07202-1614
Practice Address - Country:US
Practice Address - Phone:908-354-1490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI02476300122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist