Provider Demographics
NPI:1720327984
Name:BEVILLE, IVY L (RDH)
Entity Type:Individual
Prefix:
First Name:IVY
Middle Name:L
Last Name:BEVILLE
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3375 E 1/4 RD
Mailing Address - Street 2:
Mailing Address - City:CLIFTON
Mailing Address - State:CO
Mailing Address - Zip Code:81520-8019
Mailing Address - Country:US
Mailing Address - Phone:970-812-6198
Mailing Address - Fax:
Practice Address - Street 1:195 W 14TH
Practice Address - Street 2:GARFIELD PUBLIC HEALTH
Practice Address - City:RIFLE
Practice Address - State:CO
Practice Address - Zip Code:81650-4700
Practice Address - Country:US
Practice Address - Phone:970-625-5200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-07
Last Update Date:2013-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO906264124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist