Provider Demographics
NPI:1952673782
Name:ERNST, IRWIN MARVIN (DDS)
Entity Type:Individual
Prefix:
First Name:IRWIN
Middle Name:MARVIN
Last Name:ERNST
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 1:7150 N NOB HILL RD
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-1839
Mailing Address - Country:US
Mailing Address - Phone:954-722-0360
Mailing Address - Fax:954-722-1305
Practice Address - Street 1:7150 N NOB HILL RD
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-1839
Practice Address - Country:US
Practice Address - Phone:954-722-0360
Practice Address - Fax:954-722-1305
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL78501223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice