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General NPI Number Information
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NPI Number | 1588922272
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Entity Type | Organization
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Legal Business Name | IVY 2 DENTAL, PLLC
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Dates
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Enumeration Date | 05/01/2012
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 23478 N. SUNDANCE PKWY WEST, SUITE 103
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City | BUCKEYE
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State | AZ
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Zip | 85326-3118
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Country | US
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Telephone | 623-444-9999
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Fax |
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Provider Business Mailing Address
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Address Line | 23374 W YUMA RD STE. 102
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City | BUCKEYE
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State | AZ
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Zip | 85326-3118
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Country | US
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Telephone | 978-328-2886
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. UMAR IMTIAZ
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Credential |
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Telephone | 978-328-2886
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | 7256
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License Number State | AZ
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