Provider Demographics
NPI:1073761540
Name:IVEY, JOHN DEMPSEY (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:DEMPSEY
Last Name:IVEY
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 1:1358 EWING ST
Mailing Address - Street 2:
Mailing Address - City:NOKOMIS
Mailing Address - State:FL
Mailing Address - Zip Code:34275-1702
Mailing Address - Country:US
Mailing Address - Phone:941-484-6716
Mailing Address - Fax:941-484-6716
Practice Address - Street 1:1358 EWING ST
Practice Address - Street 2:
Practice Address - City:NOKOMIS
Practice Address - State:FL
Practice Address - Zip Code:34275-1702
Practice Address - Country:US
Practice Address - Phone:941-484-6716
Practice Address - Fax:941-484-6716
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2009-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 5412122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist