NPIMap

Organization Active NPI

Ivy 2 Dental PLLC

  • Pediatric Dentistry
  • Avondale, AZ
National Provider Identifier
1689100885
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
13075 W McDowell Rd
Suite D-100
Avondale, AZ 85392-6436
Phone
(623) 322-8999
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, DDS
Title
Associate Provider
Phone
(623) 444-9999

Specialties & licenses 1

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

Addresses

Primary practice location

13075 W McDowell Rd
Suite D-100
Avondale, AZ 85392-6436

Mailing address

13075 W McDowell Rd
Suite D-100
Avondale, AZ 85392-6436
Phone (623) 322-8999

Other identifiers 1

IdentifierTypeStateIssuer
287411MedicaidAZ

Other names 1

  • SILVERSTONE PEDIATRIC GROUP, PLLC Former legal business name

National Provider Directory

National Provider Directory
Part of
Ivy 2 Dental PLLC

Locations

13075 W McDowell Rd
Ste D100
Avondale, AZ 85392
Phone (623) 322-8999

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 5

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": "1689100885",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13075 W MCDOWELL RD",
            "address_2": "SUITE D-100",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853926436",
            "telephone_number": "623-322-8999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13075 W MCDOWELL RD",
            "address_2": "SUITE D-100",
            "city": "AVONDALE",
            "state": "AZ",
            "postal_code": "853926436",
            "telephone_number": "623-322-8999"
        }
    ],
    "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": "287411",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "SILVERSTONE PEDIATRIC GROUP, PLLC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Avondale, 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.