Provider Demographics
NPI:1912161001
Name:IHNEN, JOHN WILLIAM (DMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WILLIAM
Last Name:IHNEN
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 1:2045 GULF OF MEXICO DR
Mailing Address - Street 2:610
Mailing Address - City:LONGBOAT KEY
Mailing Address - State:FL
Mailing Address - Zip Code:34228-3251
Mailing Address - Country:US
Mailing Address - Phone:941-383-4556
Mailing Address - Fax:
Practice Address - Street 1:6084 14TH ST W
Practice Address - Street 2:SUITE B5
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34207-4104
Practice Address - Country:US
Practice Address - Phone:941-727-8805
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-17
Last Update Date:2008-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN183961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice