Provider Demographics
NPI:1780016113
Name:IVYROSE FAMILY DENTISTRY
Entity Type:Organization
Organization Name:IVYROSE FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:682-518-5655
Mailing Address - Street 1:2170 MATLOCK RD
Mailing Address - Street 2:STE 100
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-3814
Mailing Address - Country:US
Mailing Address - Phone:682-518-5655
Mailing Address - Fax:
Practice Address - Street 1:2131 N COLLINS ST
Practice Address - Street 2:STE 415
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76011-2849
Practice Address - Country:US
Practice Address - Phone:682-518-5655
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-08
Last Update Date:2013-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty