Provider Demographics
NPI:1770990574
Name:CHIKVASHVILI, MARIKA (DDS)
Entity type:Individual
Prefix:DR
First Name:MARIKA
Middle Name:
Last Name:CHIKVASHVILI
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 1:755 PARK AVE
Mailing Address - Street 2:SUITE 180
Mailing Address - City:HUNTINGTON
Mailing Address - State:NY
Mailing Address - Zip Code:11743-3975
Mailing Address - Country:US
Mailing Address - Phone:631-261-5100
Mailing Address - Fax:
Practice Address - Street 1:755 PARK AVE
Practice Address - Street 2:SUITE 180
Practice Address - City:HUNTINGTON
Practice Address - State:NY
Practice Address - Zip Code:11743-3975
Practice Address - Country:US
Practice Address - Phone:631-261-5100
Practice Address - Fax:631-261-5665
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-14
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0572941223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics