Provider Demographics
NPI:1477744282
Name:ISTVAN, ILDIKO E (DMD)
Entity Type:Individual
Prefix:DR
First Name:ILDIKO
Middle Name:E
Last Name:ISTVAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11982 NE GLISAN ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97220-2143
Mailing Address - Country:US
Mailing Address - Phone:971-373-4620
Mailing Address - Fax:971-373-4620
Practice Address - Street 1:443 NW BURNSIDE RD
Practice Address - Street 2:
Practice Address - City:GRESHAM
Practice Address - State:OR
Practice Address - Zip Code:97030-3714
Practice Address - Country:US
Practice Address - Phone:541-726-9300
Practice Address - Fax:541-726-9449
Is Sole Proprietor?:No
Enumeration Date:2007-08-06
Last Update Date:2016-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD89031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice