Provider Demographics
NPI:1184869562
Name:KVYATKOVSKAYA, TATYANA V (DDS)
Entity type:Individual
Prefix:MRS
First Name:TATYANA
Middle Name:V
Last Name:KVYATKOVSKAYA
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 1:258 DENSLOWE DR
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94132-2648
Mailing Address - Country:US
Mailing Address - Phone:415-586-8602
Mailing Address - Fax:
Practice Address - Street 1:4585 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94112-2603
Practice Address - Country:US
Practice Address - Phone:415-584-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-12
Last Update Date:2010-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA563081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice