Provider Demographics
NPI:1881131415
Name:KRIVCA, MIRANDA (DDS)
Entity type:Individual
Prefix:DR
First Name:MIRANDA
Middle Name:
Last Name:KRIVCA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:134 SUNKEN MEADOW RD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-2527
Mailing Address - Country:US
Mailing Address - Phone:347-209-4779
Mailing Address - Fax:
Practice Address - Street 1:2175 WANTAGH AVE
Practice Address - Street 2:
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-3972
Practice Address - Country:US
Practice Address - Phone:516-409-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-20
Last Update Date:2025-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist