Provider Demographics
NPI:1285150805
Name:SEIBT, IVY NGUYEN (DMD)
Entity type:Individual
Prefix:DR
First Name:IVY
Middle Name:NGUYEN
Last Name:SEIBT
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 WETZEL AVE BLDG 815
Mailing Address - Street 2:
Mailing Address - City:FORT CARSON
Mailing Address - State:CO
Mailing Address - Zip Code:80913-4095
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:CMR 411 UNIT 28038
Practice Address - Street 2:
Practice Address - City:VILSECK
Practice Address - State:GERMANY
Practice Address - Zip Code:09112
Practice Address - Country:DE
Practice Address - Phone:314-590-3880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-15
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY100011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty