Provider Demographics
NPI:1568545200
Name:POPKIN, IVAN DAVID (DDS)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:DAVID
Last Name:POPKIN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 SOUTH OLDEN AVENUE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08629
Mailing Address - Country:US
Mailing Address - Phone:609-393-9600
Mailing Address - Fax:609-393-8856
Practice Address - Street 1:521 SOUTH OLDEN AVENUE
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08629
Practice Address - Country:US
Practice Address - Phone:609-393-9600
Practice Address - Fax:609-393-8856
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1007833001223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice