| Ivy Dental Care, Pllc | |
|
7915 W Loop 1604 N Ste 119 San Antonio TX 78254-4661 | |
| (210) 672-3737 | |
| (210) 672-3738 |
| Full Name | Ivy Dental Care, Pllc |
|---|---|
| Speciality | Clinic/center - Dental |
| Location | 7915 W Loop 1604 N Ste 119, San Antonio, Texas |
| Authorized Official Name and Position | Uzma Hasheem (OWNER DENTIST) |
| Authorized Official Contact | 2106723737 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy Dental Care, Pllc 7915 W Loop 1604 N Ste 119 San Antonio TX 78254-4661 Ph: (210) 672-3737 | Ivy Dental Care, Pllc 7915 W Loop 1604 N Ste 119 San Antonio TX 78254-4661 Ph: (210) 672-3737 |
| NPI Number | 1861905473 |
|---|---|
| Provider Enumeration Date | 11/06/2017 |
| Last Update Date | 11/06/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1861905473 | NPI | - | NPPES |
| 3726879 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 31852 (Texas) | Primary |
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