Provider Demographics
NPI:1366535239
Name:SCRIVO, STEVEN R (DMD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:R
Last Name:SCRIVO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:185 FAIRFIELD AVENUE
Mailing Address - Street 2:SUITE 4A
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006
Mailing Address - Country:US
Mailing Address - Phone:973-226-0063
Mailing Address - Fax:973-226-1375
Practice Address - Street 1:185 FAIRFIELD AVENUE
Practice Address - Street 2:SUITE 4A
Practice Address - City:WEST CALDWELL
Practice Address - State:NJ
Practice Address - Zip Code:07006
Practice Address - Country:US
Practice Address - Phone:973-226-0063
Practice Address - Fax:973-226-1375
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ151841223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics