Provider Demographics
NPI:1265617948
Name:IVAN A. SERDAR, DMD, INC.
Entity type:Organization
Organization Name:IVAN A. SERDAR, DMD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:ADRIAN
Authorized Official - Last Name:SERDAR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:415-397-1030
Mailing Address - Street 1:260 STOCKTON ST
Mailing Address - Street 2:FLOOR 2
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-5305
Mailing Address - Country:US
Mailing Address - Phone:415-397-1030
Mailing Address - Fax:415-397-1032
Practice Address - Street 1:260 STOCKTON ST
Practice Address - Street 2:FLOOR 2
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-5305
Practice Address - Country:US
Practice Address - Phone:415-397-1030
Practice Address - Fax:415-397-1032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA451871223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty