Provider Demographics
NPI:1538334735
Name:CENTTY, IVONNE G (DDS, MS)
Entity type:Individual
Prefix:
First Name:IVONNE
Middle Name:G
Last Name:CENTTY
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1734 ELTON RD STE 231
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20903-5722
Mailing Address - Country:US
Mailing Address - Phone:301-476-7855
Mailing Address - Fax:
Practice Address - Street 1:1734 ELTON RD STE 231
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20903-5722
Practice Address - Country:US
Practice Address - Phone:301-476-7855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD119471223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice