Individual
TIMOTHY M PIVONKA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DDS
Contact information
Practice address
361 GRANT AVE, JUNCTION CITY, KS 66441-4201
(785) 238-4711
(785) 238-4260
Mailing address
PO BOX 1107, JUNCTION CITY, KS 66441-1107
(785) 238-4711
(785) 238-4260
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
60329
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0008976
—
KS
01
—
117182
BLUE CROSS/BLUE SHIELD
KS
Enumeration date
02/27/2006
Last updated
11/15/2007
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