Provider Demographics
NPI:1891867503
Name:GREGORY M IVY DDS AND CECILIA YKEDA DDS PLC
Entity Type:Organization
Organization Name:GREGORY M IVY DDS AND CECILIA YKEDA DDS PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CECILIA
Authorized Official - Middle Name:
Authorized Official - Last Name:YKEDA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-644-5955
Mailing Address - Street 1:8342 TRAFORD LANE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:22152-1638
Mailing Address - Country:US
Mailing Address - Phone:703-644-5955
Mailing Address - Fax:703-644-1337
Practice Address - Street 1:8342 TRAFORD LANE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:VA
Practice Address - Zip Code:22152-1638
Practice Address - Country:US
Practice Address - Phone:703-644-5955
Practice Address - Fax:703-644-1337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401410477122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty