Provider Demographics
NPI:1457528960
Name:HANCOCK, IVORY LATRICE (DMD)
Entity type:Individual
Prefix:DR
First Name:IVORY
Middle Name:LATRICE
Last Name:HANCOCK
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1026 16TH ST NW
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-5715
Mailing Address - Country:US
Mailing Address - Phone:202-737-7025
Mailing Address - Fax:202-737-7027
Practice Address - Street 1:1026 16TH STREET NW
Practice Address - Street 2:SUITE 105
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-5711
Practice Address - Country:US
Practice Address - Phone:202-737-7025
Practice Address - Fax:202-737-7027
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-14
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD14183122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist