Individual
DEBORAH IVANOFF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
306 WEST 5TH AVE, NOME, AK 99762
(907) 443-3309
Mailing address
PO BOX 966, NOME, AK 99762
(907) 443-3309
Taxonomy
Speciality
Code
Description
License number
State
126800000X
Dental Assistant
Primary
06-029-EFDHA1
AK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
06-029-EFDHA1
—
AK
Enumeration date
12/15/2011
Last updated
12/15/2011
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