Provider Demographics
NPI:1548341621
Name:KRIVICHKIN, OLEG (DDS)
Entity type:Individual
Prefix:DR
First Name:OLEG
Middle Name:
Last Name:KRIVICHKIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18800 W 10 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-2654
Mailing Address - Country:US
Mailing Address - Phone:248-569-6304
Mailing Address - Fax:248-569-7914
Practice Address - Street 1:18800 W 10 MILE RD
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-2654
Practice Address - Country:US
Practice Address - Phone:248-569-6304
Practice Address - Fax:248-596-7914
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019238122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist