Provider Demographics
NPI:1790901023
Name:SANTINI, IVELYN (DDS)
Entity Type:Individual
Prefix:
First Name:IVELYN
Middle Name:
Last Name:SANTINI
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARGARITA
Other - Middle Name:IVELYN
Other - Last Name:GUEVARA SANTINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2707 TAMPA RD
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34684-3312
Mailing Address - Country:US
Mailing Address - Phone:727-785-6521
Mailing Address - Fax:727-785-6237
Practice Address - Street 1:2707 TAMPA RD
Practice Address - Street 2:
Practice Address - City:PALM HARBOR
Practice Address - State:FL
Practice Address - Zip Code:34684-3312
Practice Address - Country:US
Practice Address - Phone:727-785-6521
Practice Address - Fax:727-785-6237
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN112741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice