Provider Demographics
NPI:1831623156
Name:DAY, IAN (DMD)
Entity type:Individual
Prefix:
First Name:IAN
Middle Name:
Last Name:DAY
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 1:4850 N 9TH AVE STE 4
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2406
Mailing Address - Country:US
Mailing Address - Phone:262-287-7968
Mailing Address - Fax:
Practice Address - Street 1:4850 N 9TH AVE STE 4
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2406
Practice Address - Country:US
Practice Address - Phone:850-477-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-13
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV1001587-151223S0112X
390200000X
FL283141223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program