Provider Demographics
NPI:1104364629
Name:IVETA IONTCHEVE-BAREHMI DMD PC
Entity Type:Organization
Organization Name:IVETA IONTCHEVE-BAREHMI DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:IVETA
Authorized Official - Middle Name:
Authorized Official - Last Name:IONTCHEVE-BAREHMI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:617-868-1516
Mailing Address - Street 1:1842 BEACON ST
Mailing Address - Street 2:STE 305
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-1930
Mailing Address - Country:US
Mailing Address - Phone:617-868-1516
Mailing Address - Fax:
Practice Address - Street 1:1842 BEACON ST
Practice Address - Street 2:STE 305
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-1930
Practice Address - Country:US
Practice Address - Phone:617-868-1516
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-03
Last Update Date:2017-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty