Individual
MATTHEW KRIVARCHKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1511 W. HOLLY BOULEVARD, BRANDON, SD 57005
(605) 582-5000
Mailing address
1511 W. HOLLY BOULEVARD, BRANDON, SD 57005
(605) 582-5000
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
DO911
SD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1760738967
—
SD
Enumeration date
06/08/2009
Last updated
11/02/2012
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