Provider Demographics
NPI:1154509503
Name:IVRY, MICHAEL YEHUDA (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:YEHUDA
Last Name:IVRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 HAWKINS AVE
Mailing Address - Street 2:
Mailing Address - City:LAKE GROVE
Mailing Address - State:NY
Mailing Address - Zip Code:11755-1604
Mailing Address - Country:US
Mailing Address - Phone:631-585-6880
Mailing Address - Fax:631-585-0745
Practice Address - Street 1:44 S CENTRAL AVE STE 2
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580
Practice Address - Country:US
Practice Address - Phone:516-561-7788
Practice Address - Fax:516-596-7455
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-07
Last Update Date:2018-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0479621122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1154509503Medicaid