Active NPI
Deborah Ivanoff
- Dental Assistant
- Nome, AK
National Provider Identifier
1699044941
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dental Assistant
- License
- 06-029-EFDHA1
- Practice address
- 306 West 5TH Ave
Nome, AK 99762 - Phone
- (907) 443-3309
- NPI assigned
- Dec 15, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dental Assistant | 126800000X | 06-029-EFDHA1 | AK | Primary |
Addresses
Primary practice location
306 West 5TH Ave
Nome, AK 99762
Mailing address
PO Box 966
Nome, AK 99762
Phone (907) 443-3309
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 06-029-EFDHA1 | Medicaid | AK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 06-029-EFDHA1 | AK | MD | Dental Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1323907200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1323907200000",
"number": "1699044941",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 966",
"city": "NOME",
"state": "AK",
"postal_code": "99762",
"telephone_number": "907-443-3309"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "306 WEST 5TH AVE",
"city": "NOME",
"state": "AK",
"postal_code": "99762",
"telephone_number": "907-443-3309"
}
],
"practiceLocations": [],
"basic": {
"last_name": "IVANOFF",
"first_name": "DEBORAH",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-12-15",
"last_updated": "2011-12-15",
"status": "A"
},
"taxonomies": [
{
"code": "126800000X",
"taxonomy_group": "",
"desc": "Dental Assistant",
"state": "AK",
"license": "06-029-EFDHA1",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "06-029-EFDHA1",
"state": "AK"
}
],
"endpoints": [],
"other_names": []
}Other providers in Nome, AK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 15, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.