Provider Demographics
NPI:1952624504
Name:IVAN, MADALINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MADALINA
Middle Name:
Last Name:IVAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MADALINA
Other - Middle Name:
Other - Last Name:MARIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1420 N ARLINGTON HEIGHTS RD
Mailing Address - Street 2:SUITE #130
Mailing Address - City:ARLINGTON HEIGHTS
Mailing Address - State:IL
Mailing Address - Zip Code:60004-4824
Mailing Address - Country:US
Mailing Address - Phone:847-392-6610
Mailing Address - Fax:
Practice Address - Street 1:1420 N ARLINGTON HEIGHTS RD
Practice Address - Street 2:SUITE #130
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60004-4824
Practice Address - Country:US
Practice Address - Phone:847-392-6610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-10
Last Update Date:2014-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190282421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice