Anna Victorovna Ivanova, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DEN4564 Issued in ME

Practice address

413 Alfred St Ste 101
Biddeford, ME 04005-3742

Phone

(207) 569-8167

NPI assigned

Jun 20, 2017

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Dr. Inna Ivanova Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Seaside Maine Dentistry

  • Dental Clinic/Center
  • Biddeford, ME
  • NPI 1770179970
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1497916800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645488000000",
    "number": "1023538253",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "413 ALFRED ST STE 101",
            "city": "BIDDEFORD",
            "state": "ME",
            "postal_code": "040053742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "413 ALFRED ST STE 101",
            "city": "BIDDEFORD",
            "state": "ME",
            "postal_code": "040053742",
            "telephone_number": "207-569-8167"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVANOVA",
        "first_name": "ANNA",
        "middle_name": "VICTOROVNA",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-06-20",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "ME",
            "license": "DEN4564",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "INNA",
            "last_name": "IVANOVA",
            "prefix": "DR.",
            "credential": "DMD",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Jonathan David Hwang, PA-C
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• Jenny Ingwersen, LCPC
• Intare Healthcare Systems, LLC
• Tamara Christine Ireland, CRNA
• Olivia Jannace
• Jamie Jannarone, MS, RD, LD
• Hasan Jasim
• Jennifer M West LCSW, LLC
• Jennifer Poirier PLLC

• General Practice Dentistry in Biddeford, ME
• Providers in Biddeford, ME by specialty
• General Practice Dentistry in Maine

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.