Ivory Dental, LLC

Primary specialty

DentistTaxonomy code 122300000X

License

DD4010 Issued in NM

Legal business name

IVORY DENTAL, LLC

Practice address

5920 Whiteman Dr NW
Albuquerque, NM 87120

Phone

(505) 897-6889

Fax

(505) 922-1319

NPI assigned

Dec 12, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Brendon E Prestwich, DDS

Title

Dentist

Phone

(505) 897-6889

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1386806400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386806400000",
    "number": "1275964587",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5920 WHITEMAN DR NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "871202198",
            "telephone_number": "505-897-6889",
            "fax_number": "505-922-1319"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5920 WHITEMAN DR NW",
            "city": "ALBUQUERQUE",
            "state": "NM",
            "postal_code": "87120",
            "telephone_number": "505-897-6889",
            "fax_number": "505-922-1319"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVORY DENTAL, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-12",
        "last_updated": "2013-12-12",
        "status": "A",
        "authorized_official_last_name": "PRESTWICH",
        "authorized_official_first_name": "BRENDON",
        "authorized_official_middle_name": "E",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "505-897-6889",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "NM",
            "license": "DD4010",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jane Mae Ives, PMHNP
• Heather M Ivey, MFT INTERN
• Jennifer Ivey, M.P.T.
• Nathan D Ivey, D.P.M.
• Catherine Ivie, CTRS, ATP
• Marvelyn Yvonne Chika Iweh, MD
• Francisco Izquierdo
• Luis A Izquierdo, M.D.
• J & RS Scripts Inc
• J and I Specialist

• Dentist in Albuquerque, NM
• Providers in Albuquerque, NM by specialty
• Dentist in New Mexico

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 12, 2013; 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.