Provider Demographics
NPI:1891862884
Name:NEGRON, IVETTE M (DMD)
Entity Type:Individual
Prefix:DR
First Name:IVETTE
Middle Name:M
Last Name:NEGRON
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:MB79 PASEO DEL SOL
Mailing Address - Street 2:PARQUE DEL MONTE, ENCANTADA
Mailing Address - City:TRUJILLO ALTO
Mailing Address - State:PR
Mailing Address - Zip Code:00976-6092
Mailing Address - Country:US
Mailing Address - Phone:787-876-2042
Mailing Address - Fax:787-256-1900
Practice Address - Street 1:CARRETERA #188 INT. #187
Practice Address - Street 2:
Practice Address - City:LOIZA
Practice Address - State:PR
Practice Address - Zip Code:00772
Practice Address - Country:US
Practice Address - Phone:787-876-2042
Practice Address - Fax:787-256-1900
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16111223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice