MEDICARE: DR. IVAN NEGRON DMD

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
1	122300000X	Dentist	DN 14904	FL

General Provider Information

NPI Number	:	1225150097
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. IVAN NEGRON DMD

Provider Business Mailing Address
First Line	:	1022 W STATE ROAD 436
Second Line	:	SUITE 1008
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-2900
Country	:	US
Telephone Number	:	407-774-6622
Fax Number	:	407-774-5750

Provider Business Practice Location Address
First Line	:	1022 W STATE ROAD 436
Second Line	:	SUITE 1008
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-2900
Country	:	US
Telephone Number	:	407-774-6622
Fax Number	:	407-774-5750

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2007
Last Update Date	:	07/08/2007

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