Provider Demographics
NPI:1366786501
Name:NIVAR, VICTOR AUGUSTO (DDS)
Entity type:Individual
Prefix:
First Name:VICTOR
Middle Name:AUGUSTO
Last Name:NIVAR
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 1:809 W 177TH ST
Mailing Address - Street 2:APT. # 6A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-6629
Mailing Address - Country:US
Mailing Address - Phone:646-745-8790
Mailing Address - Fax:
Practice Address - Street 1:17 LIBERTY SQUARE MALL
Practice Address - Street 2:
Practice Address - City:STONY POINT
Practice Address - State:NY
Practice Address - Zip Code:10980-2400
Practice Address - Country:US
Practice Address - Phone:845-429-1293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-10
Last Update Date:2019-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024128124Q00000X
NY060361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No124Q00000XDental ProvidersDental Hygienist