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General NPI Number Information
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NPI Number | 1548832900
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Entity Type | Individual
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Provider Name | NATALIIA IVANIV DMD
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Gender | Female
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Dates
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Enumeration Date | 07/14/2021
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Last Update Date | 08/18/2021
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Provider Practice Location Address
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Address Line | 2327 COTTMAN AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19149-1008
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Country | US
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Telephone | 215-332-8700
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Fax |
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Provider Business Mailing Address
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Address Line | 800 CHARETTE RD
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City | PHILADELPHIA
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State | PA
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Zip | 19115-3504
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Country | US
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Telephone | 484-795-9353
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DS043210
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License Number State | PA
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