Provider Demographics
NPI:1457459687
Name:SERDAR, IVAN ADRIAN (DMD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:ADRIAN
Last Name:SERDAR
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 1:260 STOCKTON ST
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-5305
Mailing Address - Country:US
Mailing Address - Phone:415-397-1030
Mailing Address - Fax:415-397-1032
Practice Address - Street 1:260 STOCKTON ST
Practice Address - Street 2:FLOOR 2
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-5305
Practice Address - Country:US
Practice Address - Phone:415-397-1030
Practice Address - Fax:415-397-1032
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice