Pavel Ivanov Ivanov, D.M.D.

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

DN19160 Issued in FL

Practice address

12866 Biscayne Blvd
North Miami, FL 33181-2007

Phone

(786) 540-1919

NPI assigned

Nov 29, 2012

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ivanov Miami Lakes PLLC

  dba Ivanov Orthodontics

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • Miami Lakes, FL
  • NPI 1245038462
  NPD Authorized official
• Pavel I Ivanov DMD Ms PA

  dba IVANOV Orthodontic Experts

  • Orthodontics and Dentofacial Orthopedics Dentistry
  • North Miami, FL
  • NPI 1306485776
  NPD Authorized official

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

{
    "created_epoch": "1354147200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1577923200000",
    "number": "1790020824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12866 BISCAYNE BLVD",
            "city": "NORTH MIAMI",
            "state": "FL",
            "postal_code": "331812007"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12866 BISCAYNE BLVD",
            "city": "NORTH MIAMI",
            "state": "FL",
            "postal_code": "331812007",
            "telephone_number": "786-540-1919"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "IVANOV",
        "first_name": "PAVEL",
        "middle_name": "IVANOV",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-11-29",
        "last_updated": "2020-01-02",
        "certification_date": "2020-01-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "FL",
            "license": "DN19160",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Nyota Roshanda Jackman

• Orthodontics and Dentofacial Orthopedics Dentistry in North Miami, FL
• Providers in North Miami, FL by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; 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.