Provider Demographics
NPI:1336696426
Name:DMITRIY PIVNIK DDS INC
Entity Type:Organization
Organization Name:DMITRIY PIVNIK DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DMITRIY
Authorized Official - Middle Name:
Authorized Official - Last Name:PIVNIK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:415-412-3158
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:562-577-5641
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:916-783-5239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-06
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1001811223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1275991721Medicaid