Provider Demographics
NPI:1407245160
Name:SPIVAK, KARINA (DMD)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:
Last Name:SPIVAK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3978 WHITE ROSE WAY
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5822
Mailing Address - Country:US
Mailing Address - Phone:410-205-0024
Mailing Address - Fax:
Practice Address - Street 1:690 RITCHIE HWY
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-3942
Practice Address - Country:US
Practice Address - Phone:410-647-0800
Practice Address - Fax:410-544-3652
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-20
Last Update Date:2015-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD138301223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics