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Organization
NSLIJ DENTAL MEDICINE
Active
Organization
NSLIJ DENTAL MEDICINE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. MIRANDA KRIVCA DDS (DENTAL GENERAL PRACTICE RESIDENT)
(347) 209-4779
Entity
Organization
Contact information
Practice address
400 COMMUNITY DR, MANHASSET, NY 11030-3815
(347) 209-4779
Mailing address
400 COMMUNITY DR, MANHASSET, NY 11030-3815
(347) 209-4779
Taxonomy
Speciality
Code
Description
License number
State
261QD0000X
Dental Clinic/Center
Primary
—
NULL
Other
Enumeration date
03/05/2015
Last updated
10/24/2015
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