Provider Demographics
NPI:1922190974
Name:IVINS, JOYCE ROE JR (DDS)
Entity type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:ROE
Last Name:IVINS
Suffix:JR
Gender:M
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:PO BOX 800
Mailing Address - Street 2:
Mailing Address - City:FARWELL
Mailing Address - State:TX
Mailing Address - Zip Code:79325-0800
Mailing Address - Country:US
Mailing Address - Phone:806-481-3336
Mailing Address - Fax:805-481-3339
Practice Address - Street 1:301 THIRD STREET
Practice Address - Street 2:
Practice Address - City:FARWELL
Practice Address - State:TX
Practice Address - Zip Code:79325-0800
Practice Address - Country:US
Practice Address - Phone:806-481-3336
Practice Address - Fax:805-481-3339
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116081223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX826119OtherCHIPS
TXTX11608OtherDENTAL BOARD