Provider Demographics
NPI:1912125550
Name:DEAN, IVELINA NEDELCHEVA (DMD)
Entity type:Individual
Prefix:DR
First Name:IVELINA
Middle Name:NEDELCHEVA
Last Name:DEAN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:IVELINA
Other - Middle Name:NEDELCHEVA
Other - Last Name:JURKOWSKI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:261 HELTON LN
Mailing Address - Street 2:
Mailing Address - City:FORT MILL
Mailing Address - State:SC
Mailing Address - Zip Code:29708-0075
Mailing Address - Country:US
Mailing Address - Phone:803-207-4266
Mailing Address - Fax:
Practice Address - Street 1:1741 GOLD HILL RD STE 2010
Practice Address - Street 2:
Practice Address - City:FORT MILL
Practice Address - State:SC
Practice Address - Zip Code:29708-8205
Practice Address - Country:US
Practice Address - Phone:803-548-3342
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC9881223P0300X
CTCT10343390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes1223P0300XDental ProvidersDentistPeriodontics