Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 2901018599 | MI |
NPI | 1003870908 |
---|---|
Provider Name | Dr. Nathan D Krivitzky |
First Address | Apo, AE 09601 |
Second Address | Apo, AE 09601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2006 |
Last Update Date | 20/04/2008 |