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Organization

IVY 2 DENTAL PLLC

Active
Parent organization
IVY 2 DENTAL PLLC
Other names
SILVERSTONE PEDIATRIC GROUP, 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
13075 W MCDOWELL RD, SUITE D-100, AVONDALE, AZ 85392-6436
(623) 322-8999
Mailing address
13075 W MCDOWELL RD, SUITE D-100, AVONDALE, AZ 85392-6436
(623) 322-8999

Taxonomy

Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
7256
AZ

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
287411
AZ
Enumeration date
05/08/2017
Last updated
07/20/2021
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