Provider Demographics
NPI:1588751986
Name:TOVAR, IVAN D (DDS)
Entity type:Individual
Prefix:DR
First Name:IVAN
Middle Name:D
Last Name:TOVAR
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 1:9784 W YEARLING RD
Mailing Address - Street 2:SUITE B-1500
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-1379
Mailing Address - Country:US
Mailing Address - Phone:623-561-1470
Mailing Address - Fax:623-561-1169
Practice Address - Street 1:9784 W. YEARLING RD
Practice Address - Street 2:SUITE B-1500
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383
Practice Address - Country:US
Practice Address - Phone:623-561-1470
Practice Address - Fax:623-561-1169
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ59281223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice