1760738967 NPI number — KRIVARCHKA FAMILY DENTISTRY P.C.

Table of content: DR. CLAIRE LOUISE BUCHANAN M.D. (NPI 1689754467)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760738967 NPI number — KRIVARCHKA FAMILY DENTISTRY P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KRIVARCHKA FAMILY DENTISTRY P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1760738967
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7608 W GRINNELL CIR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SIOUX FALLS
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57106-7669
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-951-1084
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1511 W HOLLY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRANDON
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57005-2658
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-951-1084
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KRIVARCHKA
Authorized Official First Name:
MATT
Authorized Official Middle Name:
VICTOR
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
605-951-1084

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , with the licence number:  D0911 , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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