Provider Demographics
NPI:1760408645
Name:ALVAREZ, IVIS (DMD)
Entity Type:Individual
Prefix:DR
First Name:IVIS
Middle Name:
Last Name:ALVAREZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7807 BAYMEADOWS RD E
Mailing Address - Street 2:STE 305
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32256-9664
Mailing Address - Country:US
Mailing Address - Phone:904-641-7455
Mailing Address - Fax:904-641-8545
Practice Address - Street 1:7807 BAYMEADOWS RD E
Practice Address - Street 2:STE 305
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32256-9664
Practice Address - Country:US
Practice Address - Phone:904-641-7455
Practice Address - Fax:904-641-8545
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN141761223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry