Individual
NICHOLE IVANOV
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RDH, BS
Contact information
Practice address
220 W GARFIELD AVE, CHARLEVOIX, MI 49720-1631
(231) 547-7620
Mailing address
5763 STONEBRIDGE DR SW, GRANDVILLE, MI 49418-3240
(231) 649-7102
Taxonomy
Speciality
Code
Description
License number
State
124Q00000X
Dental Hygienist
Primary
—
—
Other
Enumeration date
04/24/2022
Last updated
04/24/2022
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