Provider Demographics
NPI:1093897787
Name:IVORY DENTISTRY P.A
Entity type:Organization
Organization Name:IVORY DENTISTRY P.A
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RASHMI
Authorized Official - Middle Name:
Authorized Official - Last Name:PAWAR
Authorized Official - Suffix:
Authorized Official - Credentials:D D S
Authorized Official - Phone:214-488-3368
Mailing Address - Street 1:2601 S STEMMONS FWY
Mailing Address - Street 2:STE # 160
Mailing Address - City:LEWISVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75067-4137
Mailing Address - Country:US
Mailing Address - Phone:214-488-3368
Mailing Address - Fax:214-466-8957
Practice Address - Street 1:2601 S STEMMONS FWY
Practice Address - Street 2:STE # 160
Practice Address - City:LEWISVILLE
Practice Address - State:TX
Practice Address - Zip Code:75067-4137
Practice Address - Country:US
Practice Address - Phone:214-488-3368
Practice Address - Fax:214-466-8957
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX214811223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty