Provider Demographics
NPI:1245323633
Name:IVAN, OANA R (DDS)
Entity type:Individual
Prefix:
First Name:OANA
Middle Name:R
Last Name:IVAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 DELAWARE ST SE
Mailing Address - Street 2:9-470 MOOSE TOWER
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455-0357
Mailing Address - Country:US
Mailing Address - Phone:612-626-5161
Mailing Address - Fax:612-626-1496
Practice Address - Street 1:515 DELAWARE ST SE
Practice Address - Street 2:9-470 MOOSE TOWER
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0357
Practice Address - Country:US
Practice Address - Phone:612-626-5161
Practice Address - Fax:612-626-1496
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2019-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11854122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist