Provider Demographics
NPI:1851941439
Name:IVETTE JORGE DMD, MPH PLLC
Entity Type:Organization
Organization Name:IVETTE JORGE DMD, MPH PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:JORGE
Authorized Official - Suffix:
Authorized Official - Credentials:DMD, MPH
Authorized Official - Phone:602-274-8181
Mailing Address - Street 1:3030 N 3RD ST STE 900
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-3048
Mailing Address - Country:US
Mailing Address - Phone:602-274-8181
Mailing Address - Fax:602-274-8181
Practice Address - Street 1:3030 N 3RD ST STE 900
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-3048
Practice Address - Country:US
Practice Address - Phone:602-274-8181
Practice Address - Fax:602-274-8181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental