Provider Demographics
NPI:1831291368
Name:PIVOR, JEFFREY MARK (DDS)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:MARK
Last Name:PIVOR
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 CONNECTICUT AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06854-1723
Mailing Address - Country:US
Mailing Address - Phone:203-838-3321
Mailing Address - Fax:203-838-3314
Practice Address - Street 1:495 CONNECTICUT AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06854-1723
Practice Address - Country:US
Practice Address - Phone:203-838-3321
Practice Address - Fax:203-838-3314
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT053101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice