Provider Demographics
NPI:1326725813
Name:THE IVORY DENTAL STUDIO
Entity Type:Organization
Organization Name:THE IVORY DENTAL STUDIO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER / GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRITTNEY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:JASEK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:224-234-9304
Mailing Address - Street 1:1114 BARRINGTON CT
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-1388
Mailing Address - Country:US
Mailing Address - Phone:224-234-9304
Mailing Address - Fax:
Practice Address - Street 1:1906 US HIGHWAY 41
Practice Address - Street 2:SUITE A
Practice Address - City:SCHERERVILLE
Practice Address - State:IN
Practice Address - Zip Code:46375
Practice Address - Country:US
Practice Address - Phone:219-554-8679
Practice Address - Fax:219-554-8679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-28
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty