Provider Demographics
NPI:1417040817
Name:ZIVARI, DEBORA (DDS)
Entity Type:Individual
Prefix:MRS
First Name:DEBORA
Middle Name:
Last Name:ZIVARI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 10 YELLOWSTONE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORESTHILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375
Mailing Address - Country:US
Mailing Address - Phone:718-520-9106
Mailing Address - Fax:718-520-6527
Practice Address - Street 1:69 10 YELLOWSTONE BLVD
Practice Address - Street 2:
Practice Address - City:FORESTHILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-520-9106
Practice Address - Fax:718-520-6527
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0431631122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01212335Medicaid