Organization
IVORY PEDIATRIC DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ADRIENNE ARCHIDIACONO (PRACTICE OWNER/PEDIATRIC DENTIST)
(817) 406-2025
Entity
Organization
Contact information
Practice address
311 S FM 1187 STE 300, ALEDO, TX 76008-6452
(817) 406-2025
Mailing address
311 S FM 1187 STE 300, ALEDO, TX 76008-6452
Taxonomy
Speciality
Code
Description
License number
State
1223P0221X
Pediatric Dentistry
Primary
—
—
Other
Enumeration date
09/20/2022
Last updated
09/20/2022
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