Organization
IVY 2 DENTAL PLLC
Active
Parent organization
IVY 2 DENTAL PLLC
Other names
WOPD, PLLC
Organization subpart
Yes
Provider details
NPI number
Legal business name
IVY 2 DENTAL PLLC
Authorized official
UMAR M IMTIAZ DDS (ASSOCIATE PROVIDER)
(623) 444-9999
Entity
Organization
Contact information
Practice address
5144 W OLIVE AVE, GLENDALE, AZ 85302-4209
(623) 939-9944
Mailing address
5144 W OLIVE AVE, GLENDALE, AZ 85302-4209
(623) 939-9944
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
7256
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
274792
—
AZ
Enumeration date
05/08/2017
Last updated
07/20/2021
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