| Ivy Dental | |
|
460 Ashley Ridge Blvd Ste 600 Shreveport LA 71106-7238 | |
| (318) 868-4188 | |
| (318) 868-9151 |
| Full Name | Ivy Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 460 Ashley Ridge Blvd Ste 600, Shreveport, Louisiana |
| Authorized Official Name and Position | Andretta Rrenee Porter-williams (OWNER) |
| Authorized Official Contact | 3188684188 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivy Dental 460 Ashley Ridge Blvd Ste 600 Shreveport LA 71106-7238 Ph: (318) 868-4188 | Ivy Dental 460 Ashley Ridge Blvd Ste 600 Shreveport LA 71106-7238 Ph: (318) 868-4188 |
| NPI Number | 1063792752 |
|---|---|
| Provider Enumeration Date | 08/25/2011 |
| Last Update Date | 08/25/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063792752 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 4645 (Louisiana) | Primary |
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