Ivodent Group PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

IVODENT GROUP PLLC

Doing business as

Legacy Park Dental

Practice address

1001 NE Green Oaks Blvd
129
Arlington, TX 76006-2318

Phone

(817) 789-4480

NPI assigned

Oct 15, 2014

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Jacki Dang

Title

Practice Manager

Phone

(817) 703-3791

Specialties & licenses 1

Addresses

Other names 1

• Legacy Park Dental Doing business as

Tax ID family

Great Oak Dental2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Ivodent Group, PLLC

  dba Great Oak Dental

  • Dental Clinic/Center
  • Arlington, TX
  • NPI 1023356359
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jackilyn Dang, DMD

  • Dentist
  • Arlington, TX
  • NPI 1386923811

  General Practice

  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1413331200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1413331200000",
    "number": "1093119331",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1001 NE GREEN OAKS BLVD",
            "address_2": "129",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760062318"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1001 NE GREEN OAKS BLVD",
            "address_2": "129",
            "city": "ARLINGTON",
            "state": "TX",
            "postal_code": "760062318",
            "telephone_number": "817-789-4480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVODENT GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2014-10-15",
        "last_updated": "2014-10-15",
        "status": "A",
        "authorized_official_last_name": "DANG",
        "authorized_official_first_name": "JACKI",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "817-703-3791"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Legacy Park Dental",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Ashley Ison, PHARM D
• Israel a Hartman M D P a
• Amana Israel, COTA/L
• Patience Itoya
• Iunity Home Care LLC
• Ivodent Group, PLLC (Great Oak Dental)
• Richard Glenn Ivy Jr., D.C.
• Ivyrose Family Dentistry
• Amir H Izaddoust, D.D.S.
• Precious K Izah

• General Practice Dentistry in Arlington, TX
• Providers in Arlington, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 15, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.