Provider Demographics
NPI:1508206533
Name:GEORGIEV, IVAN GEORGIEV (DMD)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:GEORGIEV
Last Name:GEORGIEV
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 1:9-12 HENDERSON BLVD
Mailing Address - Street 2:1ST. FL.
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1536
Mailing Address - Country:US
Mailing Address - Phone:201-847-1365
Mailing Address - Fax:
Practice Address - Street 1:703 MAIN ST
Practice Address - Street 2:OMFS CLINIC
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07503-2621
Practice Address - Country:US
Practice Address - Phone:973-754-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DR026161223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery