| Ivy 2 Dental Pllc | |
|
5144 W Olive Ave Glendale AZ 85302-4209 | |
| (623) 939-9944 | |
| Not Available |
| Full Name | Ivy 2 Dental Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 5144 W Olive 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 5144 W Olive Ave Glendale AZ 85302-4209 Ph: (623) 939-9944 | Ivy 2 Dental Pllc 5144 W Olive Ave Glendale AZ 85302-4209 Ph: (623) 939-9944 |
| NPI Number | 1306372503 |
|---|---|
| Provider Enumeration Date | 05/08/2017 |
| Last Update Date | 07/20/2021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306372503 | NPI | - | NPPES |
| 274792 | Medicaid | AZ |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223P0221X | Dentist - Pediatric Dentistry | 7256 (Arizona) | Primary |
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