Provider Demographics
NPI:1518785039
Name:BRIAN M. HIVICK, DDS, LLC
Entity type:Organization
Organization Name:BRIAN M. HIVICK, DDS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:ZARITSKY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-590-1923
Mailing Address - Street 1:5189 CHILLICOTHE RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-4171
Mailing Address - Country:US
Mailing Address - Phone:440-338-1711
Mailing Address - Fax:
Practice Address - Street 1:5189 CHILLICOTHE RD
Practice Address - Street 2:
Practice Address - City:CHAGRIN FALLS
Practice Address - State:OH
Practice Address - Zip Code:44022-4171
Practice Address - Country:US
Practice Address - Phone:440-338-1711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-02
Last Update Date:2024-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty