Provider Demographics
NPI:1417539305
Name:IVRY, MIRIAM R (DDS)
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:R
Last Name:IVRY
Suffix:
Gender:
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6767 BURNS ST APT 2K
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-3503
Mailing Address - Country:US
Mailing Address - Phone:516-587-1120
Mailing Address - Fax:
Practice Address - Street 1:214 GRAND AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06513-3721
Practice Address - Country:US
Practice Address - Phone:203-859-5239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0629041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice