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General NPI Number Information
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NPI Number | 1134608581
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Entity Type | Organization
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Legal Business Name | IVORY HANCOCK DMD,PC
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Dates
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Enumeration Date | 08/07/2018
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Last Update Date | 08/07/2018
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Provider Practice Location Address
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Address Line | 1026 16TH ST NW STE 105
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City | WASHINGTON
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State | DC
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Zip | 20036-5711
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Country | US
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Telephone | 202-737-7025
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Fax |
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Provider Business Mailing Address
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Address Line | 1026 16TH ST NW STE 105
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City | WASHINGTON
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State | DC
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Zip | 20036-5711
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Country | US
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Telephone | 202-737-7025
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | IVORY HANCOCK
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Credential | DMD
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Telephone | 202-737-7025
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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 | 100722
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License Number State | DC
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