Provider Demographics
NPI:1679874341
Name:REES, IVAN DELANO (DDS)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:DELANO
Last Name:REES
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 1:25612 BARTON RD
Mailing Address - Street 2:#168
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3110
Mailing Address - Country:US
Mailing Address - Phone:951-522-4090
Mailing Address - Fax:
Practice Address - Street 1:1172 CADILLAC CT
Practice Address - Street 2:
Practice Address - City:MILPITAS
Practice Address - State:CA
Practice Address - Zip Code:95035-3025
Practice Address - Country:US
Practice Address - Phone:408-946-9800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-10
Last Update Date:2013-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY055383122300000X
CA623601223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223D0004XDental ProvidersDentistDentist Anesthesiologist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No122300000XDental ProvidersDentist