Provider Demographics
NPI:1407141864
Name:KOVITCH, MARIANNA LIBKIND (DMD)
Entity type:Individual
Prefix:DR
First Name:MARIANNA
Middle Name:LIBKIND
Last Name:KOVITCH
Suffix:
Gender:
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4608 LOWER ROSWELL RD
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30068-4237
Mailing Address - Country:US
Mailing Address - Phone:770-615-6510
Mailing Address - Fax:770-615-6511
Practice Address - Street 1:4608 LOWER ROSWELL RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-4237
Practice Address - Country:US
Practice Address - Phone:770-615-6510
Practice Address - Fax:770-615-6511
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-14
Last Update Date:2025-05-08
Deactivation Date:2024-09-25
Deactivation Code:
Reactivation Date:2024-10-02
Provider Licenses
StateLicense IDTaxonomies
GADN014252122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist