| Ivy 2 Dental Pllc | |
|
17570 N 75th Ave Suite E500 Glendale AZ 85308-5999 | |
| (623) 322-9919 | |
| Not Available |
| Full Name | Ivy 2 Dental Pllc |
|---|---|
| Speciality | Dentist |
| Location | 17570 N 75th Ave, Glendale, Arizona |
| Authorized Official Name and Position | Umar M Imtiaz (ASSOCIATE PROVIDER) |
| Authorized Official Contact | 6234449999 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy 2 Dental Pllc 17570 N 75th Ave Suite E500 Glendale AZ 85308-5999 Ph: (623) 322-9919 | Ivy 2 Dental Pllc 17570 N 75th Ave Suite E500 Glendale AZ 85308-5999 Ph: (623) 322-9919 |
| NPI Number | 1760918965 |
|---|---|
| Provider Enumeration Date | 05/08/2017 |
| Last Update Date | 07/20/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760918965 | NPI | - | NPPES |
| 274819 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 122300000X | Dentist | 7256 (Arizona) | Primary |
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