Provider Demographics
NPI:1528082146
Name:BERON, IVONE ARELLANO (DDS)
Entity type:Individual
Prefix:DR
First Name:IVONE
Middle Name:ARELLANO
Last Name:BERON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:IVONE
Other - Middle Name:SEVIGNE
Other - Last Name:ARELLANO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:166 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-2803
Mailing Address - Country:US
Mailing Address - Phone:630-520-9030
Mailing Address - Fax:
Practice Address - Street 1:166 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-2803
Practice Address - Country:US
Practice Address - Phone:630-520-9030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223P0221XDental ProvidersDentistPediatric Dentistry