Provider Demographics
NPI:1770467367
Name:AHLERT, IVAN JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:IVAN
Middle Name:JOSEPH
Last Name:AHLERT
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 1:612 SHADOWLAKE RD
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73071-6897
Mailing Address - Country:US
Mailing Address - Phone:918-907-1253
Mailing Address - Fax:
Practice Address - Street 1:14600 E 88TH PL N
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4877
Practice Address - Country:US
Practice Address - Phone:918-272-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK8014122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist