Provider Demographics
NPI:1164411542
Name:ALVAREZ, IVONNE (DDS)
Entity Type:Individual
Prefix:DR
First Name:IVONNE
Middle Name:
Last Name:ALVAREZ
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 1:2400 HUGHES AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10458-6109
Mailing Address - Country:US
Mailing Address - Phone:718-295-1615
Mailing Address - Fax:718-295-1616
Practice Address - Street 1:2400 HUGHES AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10458-6109
Practice Address - Country:US
Practice Address - Phone:718-295-1615
Practice Address - Fax:718-295-1616
Is Sole Proprietor?:No
Enumeration Date:2005-10-18
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050270122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02325648Medicaid