NPIMap

Organization Active NPI

Ivy 2 Dental PLLC

  • Dentist
  • Glendale, AZ
National Provider Identifier
1760918965
Registry record updated Jul 20, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
7256 Issued in AZ
Legal business name
IVY 2 DENTAL PLLC
Practice address
17570 N 75TH Ave
Suite E500
Glendale, AZ 85308-5999
Phone
(623) 322-9919
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
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X 7256 AZ Primary

Addresses

Primary practice location

17570 N 75TH Ave
Suite E500
Glendale, AZ 85308-5999

Mailing address

17570 N 75TH Ave
Suite E500
Glendale, AZ 85308-5999
Phone (623) 322-9919

Other identifiers 1

IdentifierTypeStateIssuer
274819MedicaidAZ

Other names 1

  • CIRCLE DENTAL, LLC Former legal business name

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

17570 N 75th Ave
Ste E500
Glendale, AZ 85308
Phone (623) 322-9919

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.

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": "1760918965",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17570 N 75TH AVE",
            "address_2": "SUITE E500",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853085999",
            "telephone_number": "623-322-9919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17570 N 75TH AVE",
            "address_2": "SUITE E500",
            "city": "GLENDALE",
            "state": "AZ",
            "postal_code": "853085999",
            "telephone_number": "623-322-9919"
        }
    ],
    "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": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "AZ",
            "license": "7256",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "274819",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CIRCLE DENTAL, LLC",
            "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.