Provider Demographics
NPI:1669502258
Name:VOORHEES, IVAN DARRELL (D D S)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:DARRELL
Last Name:VOORHEES
Suffix:
Gender:M
Credentials:D D S
Other - Prefix:DR
Other - First Name:DARRELL
Other - Middle Name:
Other - Last Name:VOORHEES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:8490 SCOTTISH DR
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-2143
Mailing Address - Country:US
Mailing Address - Phone:801-942-0146
Mailing Address - Fax:
Practice Address - Street 1:1343 FORT UNION BLVD
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84121-2859
Practice Address - Country:US
Practice Address - Phone:801-943-3661
Practice Address - Fax:801-943-3621
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT137260122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist