Provider Demographics
NPI:1205275153
Name:STOJANOV, IVAN (DMD)
Entity type:Individual
Prefix:
First Name:IVAN
Middle Name:
Last Name:STOJANOV
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 1:4849 BRAINARD RD
Mailing Address - Street 2:
Mailing Address - City:CHAGRIN FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44022-1509
Mailing Address - Country:US
Mailing Address - Phone:706-294-5456
Mailing Address - Fax:
Practice Address - Street 1:9500 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44195-3804
Practice Address - Country:US
Practice Address - Phone:216-440-2200
Practice Address - Fax:216-368-3627
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-24
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH30.024886207ZP0101X, 1223P0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0106XDental ProvidersDentistOral and Maxillofacial Pathology
No207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology