Provider Demographics
NPI:1568440519
Name:KRIVY, MARY KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:KAY
Last Name:KRIVY
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 1:7010 YELLOWTAIL RD.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-7368
Mailing Address - Country:US
Mailing Address - Phone:307-632-6597
Mailing Address - Fax:307-632-2170
Practice Address - Street 1:7010 YELLOWTAIL RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82009-7368
Practice Address - Country:US
Practice Address - Phone:307-632-6597
Practice Address - Fax:307-632-2170
Is Sole Proprietor?:No
Enumeration Date:2006-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY963122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist