Provider Demographics
NPI:1184636342
Name:FERREIRA, IVETTE A (DDS)
Entity Type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:A
Last Name:FERREIRA
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 1:8111 45TH AVE APT 3N
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3516
Mailing Address - Country:US
Mailing Address - Phone:718-314-2476
Mailing Address - Fax:718-651-3312
Practice Address - Street 1:8820 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:JACKSON HEIGHTS
Practice Address - State:NY
Practice Address - Zip Code:11372-7800
Practice Address - Country:US
Practice Address - Phone:718-651-3311
Practice Address - Fax:718-651-3312
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050729-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02420139Medicaid