NPIMap

Organization Active NPI

Ivy Lane Dentistry

  • General Practice Dentistry
  • San Antonio, TX
National Provider Identifier
1467539577
Registry record updated Apr 7, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
General Practice DentistryTaxonomy code 1223G0001X
License
19612 Issued in TX
Legal business name
IVY LANE DENTISTRY
Practice address
1073 Ivy LN
San Antonio, TX 78209-6061
Phone
(210) 824-9566
Fax
(210) 824-9975
NPI assigned
Nov 1, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 7, 2010

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

Authorized official

Name
Dr. Matthew Louis Westerberg, DDSNPI 1629042874
Title
Owner
Phone
(210) 824-9566

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
General Practice DentistryGroup: 193400000X SINGLE SPECIALTY GROUP 1223G0001X 19612 TX Primary

Addresses

Primary practice location

1073 Ivy LN
San Antonio, TX 78209-6061

Mailing address

1073 Ivy LN
San Antonio, TX 78209-6061
Phone (210) 824-9566

National Provider Directory

National Provider Directory

Locations

1073 Ivy Ln
San Antonio, TX 78209
Phone (210) 824-9566

Practitioners & affiliated clinicians

Practitioners 1

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": "1162339200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1270598400000",
    "number": "1467539577",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1073 IVY LN",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782096061",
            "telephone_number": "210-824-9566",
            "fax_number": "210-824-9975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1073 IVY LN",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782096061",
            "telephone_number": "210-824-9566",
            "fax_number": "210-824-9975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVY LANE DENTISTRY",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-01",
        "last_updated": "2010-04-07",
        "status": "A",
        "authorized_official_last_name": "WESTERBERG",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_middle_name": "LOUIS",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-824-9566",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "19612",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 7, 2010; 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.