Organization
KRISTOFER SIVANICH DDS PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KRISTOFER SIVANICH DDS (OWNER)
(469) 453-3055
Entity
Organization
Contact information
Practice address
6750 HORIZON RD, HEATH, TX 75032-2058
(469) 453-3055
(469) 453-3324
Mailing address
6750 HORIZON RD, HEATH, TX 75032-2058
(469) 453-3055
(469) 453-3324
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1285945089
NPI TYPE 1
TX
Enumeration date
09/20/2018
Last updated
09/20/2018
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