Healthcare Provider Details

I. General information

NPI: 1851472856
Provider Name (Legal Business Name): DAVID M IVEY DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 02/29/2024
Certification Date: 02/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11710 OLD BALLAS RD STE 205
SAINT LOUIS MO
63141-7076
US

IV. Provider business mailing address

10200 W MAIN ST
BELLEVILLE IL
62223-1408
US

V. Phone/Fax

Practice location:
  • Phone: 314-866-6725
  • Fax: 314-998-6725
Mailing address:
  • Phone: 618-400-6725
  • Fax: 618-500-6725

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number012332
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number12332
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: