NPIMap

Organization Active NPI

Ivy 2 Dental PLLC

  • Pediatric Dentistry
  • Glendale, AZ
National Provider Identifier
1306372503
Registry record updated Jul 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric DentistryTaxonomy code 1223P0221X
License
7256 Issued in AZ
Legal business name
IVY 2 DENTAL PLLC
Practice address
5144 W Olive Ave
Glendale, AZ 85302-4209
Phone
(623) 939-9944
NPI assigned
May 8, 2017
Organization subpart
Yes
Parent organization
IVY 2 DENTAL PLLCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Jul 20, 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 connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223P0221X 7256 AZ Primary

Addresses

Primary practice location

5144 W Olive Ave
Glendale, AZ 85302-4209

Mailing address

5144 W Olive Ave
Glendale, AZ 85302-4209
Phone (623) 939-9944

Other identifiers 1

IdentifierTypeStateIssuer
274792MedicaidAZ

Other names 1

  • WOPD, PLLC Former legal business name

National Provider Directory

National Provider Directory
Part of
Ivy 2 Dental PLLC

Locations

5144 W Olive Ave
Glendale, AZ 85302
Phone (623) 939-9944

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 8

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1494201600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1626739200000",
    "number": "1306372503",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5144 W OLIVE AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853024209",
            "telephone_number": "623-939-9944"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5144 W OLIVE AVE",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853024209",
            "telephone_number": "623-939-9944"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY 2 DENTAL PLLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "IVY 2 DENTAL PLLC",
        "enumeration_date": "2017-05-08",
        "last_updated": "2021-07-20",
        "certification_date": "2021-07-20",
        "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": "1223P0221X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, Pediatric Dentistry",
            "state": "AZ",
            "license": "7256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "274792",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "WOPD, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Glendale, AZ

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 20, 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.