Healthcare Provider Details

I. General information

NPI: 1730990821
Provider Name (Legal Business Name): IVORY DENTAL CENTRE PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2025
Last Update Date: 01/16/2025
Certification Date: 01/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 MASSACHUSETTS AVE NW STE G10A
WASHINGTON DC
20001-4598
US

IV. Provider business mailing address

920 MASSACHUSETTS AVE NW STE G10A
WASHINGTON DC
20001-4598
US

V. Phone/Fax

Practice location:
  • Phone: 202-621-8862
  • Fax:
Mailing address:
  • Phone: 202-621-8862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. IVORY HANCOCK
Title or Position: OWNER
Credential: DMD
Phone: 202-621-8862