NPIMap

Organization Active NPI

Ivy 2 Dental PLLC

  • Dentist
  • Tucson, AZ
National Provider Identifier
1205408622
Registry record updated Jul 14, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
IVY 2 DENTAL PLLC
Practice address
405 E Wetmore Rd Ste 101
Tucson, AZ 85705-1700
Phone
(623) 444-9999
Fax
(623) 444-6745
NPI assigned
Jul 14, 2021
Last updated
Jul 14, 2021By the provider in NPPES
Organization subpart
Yes
Parent organization
IVY 2 DENTAL, PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 14, 2021

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

Authorized official

Name
Umar M Imtiaz, DDSNPI 1871595983
Title
Associate Provider
Phone
(623) 444-9999

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193200000X MULTI-SPECIALTY GROUP 122300000X Primary
General Practice DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223G0001X
Pediatric DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223P0221X
Orthodontics and Dentofacial Orthopedics DentistryGroup: 193200000X MULTI-SPECIALTY GROUP 1223X0400X

Addresses

Primary practice location

405 E Wetmore Rd Ste 101
Tucson, AZ 85705-1700

Mailing address

23374 W Yuma Rd Ste 102
Buckeye, AZ 85326-3120
Phone (623) 444-9999

National Provider Directory

National Provider Directory
Tax ID family
Ivy 2 Dental PLLC5 organizations share this tax ID, including this one
Part of
Ivy 2 Dental PLLC

Other organizations with this tax ID 4

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

Locations

405 E Wetmore Rd
Ste 101
Tucson, AZ 85705
Phone (623) 444-9999

Ownership & related parties

Parent organization (reported in NPPES) 1

This organization reports itself as a subpart in NPPES; the parent’s legal name matches this organization in the same state.

Practitioners & affiliated clinicians

Practitioners 4

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.

NPI Registry JSON

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

{
    "created_epoch": "1626220800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626220800000",
    "number": "1205408622",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "23374 W YUMA RD STE 102",
            "city": "BUCKEYE",
            "state": "AZ",
            "postal_code": "853263120",
            "telephone_number": "623-444-9999",
            "fax_number": "623-444-6745"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "405 E WETMORE RD STE 101",
            "city": "TUCSON",
            "state": "AZ",
            "postal_code": "857051700",
            "telephone_number": "623-444-9999",
            "fax_number": "623-444-6745"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY 2 DENTAL PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IVY 2 DENTAL, PLLC",
        "enumeration_date": "2021-07-14",
        "last_updated": "2021-07-14",
        "certification_date": "2021-07-14",
        "status": "A",
        "authorized_official_last_name": "IMTIAZ",
        "authorized_official_first_name": "UMAR",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "ASSOCIATE PROVIDER",
        "authorized_official_telephone_number": "623-444-9999",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223P0221X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tucson, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 14, 2021; 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.