Provider Demographics
NPI:1255544391
Name:KLIVECKA, GIEDRIS (DMD)
Entity type:Individual
Prefix:DR
First Name:GIEDRIS
Middle Name:
Last Name:KLIVECKA
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:408 77TH ST
Mailing Address - Street 2:SUITE A3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-3243
Mailing Address - Country:US
Mailing Address - Phone:718-748-8695
Mailing Address - Fax:718-748-8267
Practice Address - Street 1:408 77TH ST
Practice Address - Street 2:SUITE A3
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-3243
Practice Address - Country:US
Practice Address - Phone:718-748-8695
Practice Address - Fax:718-748-8267
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0288261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice