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General NPI Number Information
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NPI Number | 1093119331
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Entity Type | Organization
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Legal Business Name | IVODENT GROUP PLLC
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Dates
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Enumeration Date | 10/15/2014
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Last Update Date | 10/15/2014
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Provider Practice Location Address
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Address Line | 1001 NE GREEN OAKS BLVD 129
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City | ARLINGTON
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State | TX
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Zip | 76006-2318
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Country | US
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Telephone | 817-789-4480
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Fax |
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Provider Business Mailing Address
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Address Line | 1001 NE GREEN OAKS BLVD 129
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City | ARLINGTON
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State | TX
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Zip | 76006-2318
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | JACKI DANG
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Credential |
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Telephone | 817-703-3791
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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