Provider Demographics
NPI:1669645115
Name:FLOARE, IVONNA ALEXANDRA
Entity Type:Individual
Prefix:
First Name:IVONNA
Middle Name:ALEXANDRA
Last Name:FLOARE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:IVONNA
Other - Middle Name:ALEXANDRA
Other - Last Name:FLOARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 860036
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55486-0036
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:18900 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-3929
Practice Address - Country:US
Practice Address - Phone:888-632-6212
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-04
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019779122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist