Provider Demographics
NPI:1295986339
Name:IVAN NEDELTCHEV
Entity type:Organization
Organization Name:IVAN NEDELTCHEV
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ENDODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:IVAN
Authorized Official - Middle Name:K
Authorized Official - Last Name:NEDELTCHEV
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-244-5308
Mailing Address - Street 1:22 PROSPECT ST
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-4510
Mailing Address - Country:US
Mailing Address - Phone:203-244-5308
Mailing Address - Fax:203-403-3330
Practice Address - Street 1:22 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4510
Practice Address - Country:US
Practice Address - Phone:203-244-5308
Practice Address - Fax:203-403-3330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-07
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental