Provider Demographics
NPI:1548549439
Name:RISTEVSKI, IGOR (DDS)
Entity type:Individual
Prefix:DR
First Name:IGOR
Middle Name:
Last Name:RISTEVSKI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 E. 84TH DRIVE
Mailing Address - Street 2:SUITE 106
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6465
Mailing Address - Country:US
Mailing Address - Phone:219-736-2309
Mailing Address - Fax:219-736-2328
Practice Address - Street 1:233 E. 84TH DRIVE
Practice Address - Street 2:SUITE 106
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6465
Practice Address - Country:US
Practice Address - Phone:219-736-2309
Practice Address - Fax:219-736-2328
Is Sole Proprietor?:No
Enumeration Date:2011-08-09
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12011692A1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice