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NPI Code Detail

MEDICARE: ROGER THOMAS IVEY DDS.

MEDICARE: ROGER THOMAS IVEY DDS.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice DentistryDN17404FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1DN17404OTHERFLFLORIDA STATE LICENSE

General Provider Information

NPI Number : 1073532727
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROGER THOMAS IVEY DDS.
Provider Business Mailing Address
First Line : 1050 GRAPE AVE
Second Line :
City : SAINT CLOUD
State : FL
Zip : 34769-3965
Country : US
Telephone Number : 407-343-2003
Fax Number : 407-892-6468
Provider Business Practice Location Address
First Line : 1875 BOGGY CREEK RD
Second Line :
City : KISSIMMEE
State : FL
Zip : 34744-4428
Country : US
Telephone Number : 407-343-2000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2006
Last Update Date : 07/08/2007

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Directions to “ ROGER THOMAS IVEY DDS.” Practice Location

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