Healthcare Provider Details

I. General information

NPI: 1588738645
Provider Name (Legal Business Name): CLINTON H IVES JR. D.M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/06/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

835 BELMAR PLZ
BELMAR NJ
07719-2752
US

IV. Provider business mailing address

835 BELMAR PLZ
BELMAR NJ
07719-2752
US

V. Phone/Fax

Practice location:
  • Phone: 732-280-0090
  • Fax: 732-280-0057
Mailing address:
  • Phone: 732-280-0090
  • Fax: 732-280-0057

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI00973600
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: