Kristofer Paul Sivanich, D.D.S.

Primary specialty

Pediatric DentistryTaxonomy code 1223P0221X

License

D12836 Issued in MN

Practice address

4431 68TH St
Fort Hood, TX 76544-5042

Phone

(254) 286-7401

NPI assigned

Jun 25, 2010

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Kristofer Sivanich DDS PLLC

  • Pediatric Dentistry
  • Heath, TX
  • NPI 1396229803
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1277424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476835200000",
    "number": "1285945089",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "36014 WRATTEN DR",
            "address_2": "FORT HOOD DENTAC",
            "city": "FORT HOOD",
            "state": "TX",
            "postal_code": "76544",
            "telephone_number": "763-670-7386"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4431 68TH ST",
            "city": "FORT HOOD",
            "state": "TX",
            "postal_code": "765445042",
            "telephone_number": "254-286-7401"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SIVANICH",
        "first_name": "KRISTOFER",
        "middle_name": "PAUL",
        "name_prefix": "Dr.",
        "credential": "D.D.S.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-06-25",
        "last_updated": "2016-10-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "MN",
            "license": "D12836",
            "primary": true
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "TX",
            "license": "26295",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Garjeet Singh
• Jennifer Marie Sisson, APA-C
• Cressenda Sittner, RN
• Camella Joy Sitz, FNP
• Randall R Sitz, PA
• Liam R Skiffington
• Julie Skiles, LCSW, BCD
• Kerri Slatton, RDH
• Benjamin Sluchak, DMD
• Amarion Smedley

• Pediatric Dentistry in Fort Hood, TX
• Providers in Fort Hood, TX by specialty
• Pediatric Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 19, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.