Provider Demographics
NPI:1194745331
Name:IFKOVITS, JOHN PETER (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:PETER
Last Name:IFKOVITS
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 1:1360 GASPAR AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18017-1051
Mailing Address - Country:US
Mailing Address - Phone:610-974-9419
Mailing Address - Fax:
Practice Address - Street 1:3445 HIGH POINT BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7809
Practice Address - Country:US
Practice Address - Phone:610-691-7666
Practice Address - Fax:610-317-8280
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS020853L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice