Provider Demographics
NPI:1417980665
Name:IVY DENTAL INC.
Entity Type:Organization
Organization Name:IVY DENTAL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:YY
Authorized Official - Last Name:WU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:702-678-6218
Mailing Address - Street 1:740 N EASTERN AVE
Mailing Address - Street 2:#120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89101-2850
Mailing Address - Country:US
Mailing Address - Phone:702-678-6218
Mailing Address - Fax:702-678-5102
Practice Address - Street 1:740 N EASTERN AVE
Practice Address - Street 2:#120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89101-2850
Practice Address - Country:US
Practice Address - Phone:702-678-6218
Practice Address - Fax:702-678-5102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2008-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV34681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty