Provider Demographics
NPI:1225150097
Name:NEGRON, IVAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:
Last Name:NEGRON
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 1:1022 W STATE ROAD 436
Mailing Address - Street 2:SUITE 1008
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-2900
Mailing Address - Country:US
Mailing Address - Phone:407-774-6622
Mailing Address - Fax:407-774-5750
Practice Address - Street 1:1022 W STATE ROAD 436
Practice Address - Street 2:SUITE 1008
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-2900
Practice Address - Country:US
Practice Address - Phone:407-774-6622
Practice Address - Fax:407-774-5750
Is Sole Proprietor?:No
Enumeration Date:2007-04-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN 14904122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist