Provider Demographics
NPI:1467913517
Name:ZIVARI, MICHELLE SARA (DDS)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:SARA
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 1:162 ROUTE 59
Mailing Address - Street 2:
Mailing Address - City:AIRMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3627
Mailing Address - Country:US
Mailing Address - Phone:845-352-9200
Mailing Address - Fax:845-352-9399
Practice Address - Street 1:162 ROUTE 59
Practice Address - Street 2:
Practice Address - City:AIRMONT
Practice Address - State:NY
Practice Address - Zip Code:10952-3627
Practice Address - Country:US
Practice Address - Phone:845-352-9200
Practice Address - Fax:845-352-9399
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-29
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0614201223G0001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program