Organization Name: | DR DUANE KRIVARCHKA, DDS, PC |
NPI Number: | 1275944407 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | HEATHER BERGEMANN (OFFICE MANAGER) |
Mailing Address: | 11 11th Ave W Lisbon |
State: | ND US |
Postal Code: | 58054 |
Phone Number: | 7016834455 |
Fax Number: | |
NPI Enumeration Date: | 05/09/2014 |
NPI Last Update Date: | 05/09/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QD0000X |
License Number: | 1677 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | ND |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Dental |
Taxonomy Definition: |