Provider Demographics
NPI:1730990821
Name:IVORY DENTAL CENTRE PC
Entity type:Organization
Organization Name:IVORY DENTAL CENTRE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IVORY
Authorized Official - Middle Name:
Authorized Official - Last Name:HANCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:202-621-8862
Mailing Address - Street 1:920 MASSACHUSETTS AVE NW STE G10A
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4598
Mailing Address - Country:US
Mailing Address - Phone:202-621-8862
Mailing Address - Fax:
Practice Address - Street 1:920 MASSACHUSETTS AVE NW STE G10A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4598
Practice Address - Country:US
Practice Address - Phone:202-621-8862
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-16
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Multi-Specialty