Healthcare Provider Details

I. General information

NPI: 1649198219
Provider Name (Legal Business Name): IVORY IMPLANT DENTISTRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2026
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1757 E BASELINE RD STE 109
GILBERT AZ
85233-1533
US

IV. Provider business mailing address

1757 E BASELINE RD STE 109
GILBERT AZ
85233-1533
US

V. Phone/Fax

Practice location:
  • Phone: 480-573-2026
  • Fax: 480-573-2036
Mailing address:
  • Phone: 480-573-2026
  • Fax: 480-573-2036

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: ADAM MATTHEW GARDNER
Title or Position: OFFICE MANAGER
Credential:
Phone: 480-573-2026