Provider Demographics
NPI:1588738645
Name:IVES, CLINTON H JR (DMD)
Entity type:Individual
Prefix:
First Name:CLINTON
Middle Name:H
Last Name:IVES
Suffix:JR
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:835 BELMAR PLZ
Mailing Address - Street 2:
Mailing Address - City:BELMAR
Mailing Address - State:NJ
Mailing Address - Zip Code:07719-2752
Mailing Address - Country:US
Mailing Address - Phone:732-280-0090
Mailing Address - Fax:732-280-0057
Practice Address - Street 1:835 BELMAR PLZ
Practice Address - Street 2:
Practice Address - City:BELMAR
Practice Address - State:NJ
Practice Address - Zip Code:07719-2752
Practice Address - Country:US
Practice Address - Phone:732-280-0090
Practice Address - Fax:732-280-0057
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI00973600122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ26-2867643OtherFEDERAL TAX ID
NJ9736OtherLICENSE