Provider Demographics
NPI:1952888752
Name:DUARTE, IVONNE (DDS)
Entity type:Individual
Prefix:DR
First Name:IVONNE
Middle Name:
Last Name:DUARTE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 MENDOZA AVE APT 45
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-4082
Mailing Address - Country:US
Mailing Address - Phone:305-965-7606
Mailing Address - Fax:
Practice Address - Street 1:114 MENDOZA AVE APT 45
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-4082
Practice Address - Country:US
Practice Address - Phone:305-965-7606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL236961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice