Provider Demographics
NPI:1821130840
Name:APONTE, IVAN R (DMD)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:R
Last Name:APONTE
Suffix:
Gender:M
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:NO 64 JOSE DE DIEGO STREET
Mailing Address - Street 2:PO BOX 26
Mailing Address - City:SAN LORENZO
Mailing Address - State:PR
Mailing Address - Zip Code:00754
Mailing Address - Country:US
Mailing Address - Phone:787-736-5736
Mailing Address - Fax:787-736-5736
Practice Address - Street 1:NO 64 JOSE DE DIEGO ST
Practice Address - Street 2:
Practice Address - City:SAN LORENZO
Practice Address - State:PR
Practice Address - Zip Code:00754
Practice Address - Country:US
Practice Address - Phone:787-736-5736
Practice Address - Fax:787-736-5736
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR009031223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice