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General NPI Number Information
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NPI Number | 1326725813
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Entity Type | Organization
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Legal Business Name | THE IVORY DENTAL STUDIO
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Dates
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Enumeration Date | 06/28/2023
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Last Update Date | 06/28/2023
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Provider Practice Location Address
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Address Line | 1906 US HIGHWAY 41 SUITE A
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City | SCHERERVILLE
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State | IN
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Zip | 46375
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Country | US
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Telephone | 219-554-8679
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Fax | 219-554-8679
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Provider Business Mailing Address
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Address Line | 1114 BARRINGTON CT
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City | SCHERERVILLE
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State | IN
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Zip | 46375-1388
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Country | US
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Telephone | 224-234-9304
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Fax |
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Authorized Official
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Title or Position | MEMBER / GENERAL DENTIST
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Name | DR. BRITTNEY ANN JASEK
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Credential | DMD
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Telephone | 224-234-9304
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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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