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Oral Surgery, Dental Specialists

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DEBORAH IVANOFF

Dental Assistant

Nome, Alaska

Provider NPI: 1699044941

Provider Information:
 DEBORAH  IVANOFF 
Gender: F
Sole Proprietor


Practice Location:
306 WEST 5TH AVE  NOME, AK 99762 US
Tel: 907-443-3309  Fax: --

Business Mailing Address:
PO BOX 966  NOME, AK 99762 US
Tel: 907-443-3309  Fax: --

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
Y126800000XDental Providers
Dental Assistant
AK06-029-EFDHA1

Other Provider Identifiers:

IssuerNumberStateType
06-029-EFDHA1AK05
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin



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