MEDICARE: IVORY DENTAL PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1225987399
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IVORY DENTAL PLLC

Provider Business Mailing Address
First Line	:	219 TELLER RD
Second Line	:
City	:	TRUMBULL
State	:	CT
Zip	:	06611-1422
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	59 TURNPIKE SQ
Second Line	:
City	:	MILFORD
State	:	CT
Zip	:	06460-2758
Country	:	US
Telephone Number	:	203-482-8041
Fax Number	:

Authorized Official
Title or Position	:	DENTIST
Name	:	SRILATHA DOSAPATI
Credential	:	DDS
Telephone Number	:	203-482-8041

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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