Provider Demographics
NPI:1760738967
Name:KRIVARCHKA FAMILY DENTISTRY P.C.
Entity Type:Organization
Organization Name:KRIVARCHKA FAMILY DENTISTRY P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MATT
Authorized Official - Middle Name:VICTOR
Authorized Official - Last Name:KRIVARCHKA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:605-951-1084
Mailing Address - Street 1:7608 W GRINNELL CIR
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57106-7669
Mailing Address - Country:US
Mailing Address - Phone:605-951-1084
Mailing Address - Fax:
Practice Address - Street 1:1511 W HOLLY BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:SD
Practice Address - Zip Code:57005-2658
Practice Address - Country:US
Practice Address - Phone:605-951-1084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-25
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDD09111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty