Provider Demographics
NPI:1033251020
Name:MCDERMOTT, IVAL G (DDS)
Entity Type:Individual
Prefix:DR
First Name:IVAL
Middle Name:G
Last Name:MCDERMOTT
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 ANN ST
Mailing Address - Street 2:
Mailing Address - City:FREEHOLD
Mailing Address - State:NJ
Mailing Address - Zip Code:07728-1903
Mailing Address - Country:US
Mailing Address - Phone:732-462-1084
Mailing Address - Fax:
Practice Address - Street 1:UMDNJ-NEW JERSEY DENTAL SCHOOL
Practice Address - Street 2:110 BERGEN STREET, D830
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07101
Practice Address - Country:US
Practice Address - Phone:973-972-3851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D101328900122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist