Provider Demographics
NPI:1457374779
Name:STREIF, IVAN P (DDS)
Entity Type:Individual
Prefix:DR
First Name:IVAN
Middle Name:P
Last Name:STREIF
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13998 MAPLE KNOLL WAY
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-7004
Mailing Address - Country:US
Mailing Address - Phone:763-420-3537
Mailing Address - Fax:763-420-3173
Practice Address - Street 1:13998 MAPLE KNOLL WAY
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-7004
Practice Address - Country:US
Practice Address - Phone:763-420-3537
Practice Address - Fax:763-420-3173
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN102071223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics