Provider Demographics
NPI:1275991721
Name:PIVNIK, DMITRIY (DDS)
Entity Type:Individual
Prefix:DR
First Name:DMITRIY
Middle Name:
Last Name:PIVNIK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18455 TECHNOLOGY DR
Mailing Address - Street 2:
Mailing Address - City:MORGAN HILL
Mailing Address - State:CA
Mailing Address - Zip Code:95037-2822
Mailing Address - Country:US
Mailing Address - Phone:415-412-3158
Mailing Address - Fax:
Practice Address - Street 1:18455 TECHNOLOGY DR
Practice Address - Street 2:
Practice Address - City:MORGAN HILL
Practice Address - State:CA
Practice Address - Zip Code:95037-2822
Practice Address - Country:US
Practice Address - Phone:415-412-3158
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-29
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT215421223P0221X
CA1001811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry