Provider Demographics
NPI:1073727178
Name:HERNANDEZ-RAMIREZ, IVELIS
Entity Type:Individual
Prefix:
First Name:IVELIS
Middle Name:
Last Name:HERNANDEZ-RAMIREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IVELIS
Other - Middle Name:
Other - Last Name:HERNANDEZ-RAMIREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:3622 SHANNON RD STE 101
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27707-3771
Mailing Address - Country:US
Mailing Address - Phone:239-351-6794
Mailing Address - Fax:
Practice Address - Street 1:3622 SHANNON RD STE 101
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-3771
Practice Address - Country:US
Practice Address - Phone:919-493-1402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2019-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC90921223P0700X
GA1223PO700X1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics