Individual
MS. JACKLYN ALIZA PIVOVAROV
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DDS
Contact information
Practice address
12165 ELM ST, PRINCESS ANNE, MD 21853-1358
(410) 651-5151
(410) 651-4256
Mailing address
PO BOX 1978, SALISBURY, MD 21802-1978
(410) 749-1015
(410) 749-0654
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
LL857
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119591300
—
MD
Enumeration date
06/25/2019
Last updated
07/09/2019
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