Provider Demographics
NPI:1982015483
Name:DR KRIVARCHKA DDS
Entity Type:Organization
Organization Name:DR KRIVARCHKA DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DUANE
Authorized Official - Middle Name:
Authorized Official - Last Name:KRIVARCHKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-437-2676
Mailing Address - Street 1:213 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:ENDERLIN
Mailing Address - State:ND
Mailing Address - Zip Code:58027-1306
Mailing Address - Country:US
Mailing Address - Phone:701-437-2676
Mailing Address - Fax:
Practice Address - Street 1:213 4TH AVE
Practice Address - Street 2:
Practice Address - City:ENDERLIN
Practice Address - State:ND
Practice Address - Zip Code:58027-1306
Practice Address - Country:US
Practice Address - Phone:701-437-2676
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-19
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND40796Medicaid