Provider Demographics
NPI:1174629554
Name:PARRA, IVAN ORLANDO (DDS)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:ORLANDO
Last Name:PARRA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6991 W BROWARD BLVD
Mailing Address - Street 2:STE # 101
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33317-2907
Mailing Address - Country:US
Mailing Address - Phone:954-316-4444
Mailing Address - Fax:954-316-4433
Practice Address - Street 1:6991 W BROWARD BLVD
Practice Address - Street 2:STE # 101
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33317-2907
Practice Address - Country:US
Practice Address - Phone:954-316-4444
Practice Address - Fax:954-316-4433
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN16116122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist