Provider Demographics
NPI:1407162381
Name:IVRY, GIL B (DDS)
Entity Type:Individual
Prefix:
First Name:GIL
Middle Name:B
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 1:2726 PACIFIC AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-4406
Mailing Address - Country:US
Mailing Address - Phone:805-453-0951
Mailing Address - Fax:
Practice Address - Street 1:10833 LECONTE AVE
Practice Address - Street 2:A0-156 CHS
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-825-0834
Practice Address - Fax:310-794-2198
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA596651223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery