NPIMap

Organization Active NPI

Ivory Denture Care, Inc.

  • Denturist
  • Yakima, WA
National Provider Identifier
1922164557
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
DenturistTaxonomy code 122400000X
License
DN00000367 Issued in WA
Legal business name
IVORY DENTURE CARE, INC.
Practice address
210 S 11TH Ave
Suite #45
Yakima, WA 98902-3293
Phone
(509) 454-2273
Fax
(509) 454-7901
NPI assigned
Dec 28, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

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

Authorized official

Name
William S. Disantis, D.D.NPI 1306902929
Title
Owner
Phone
(509) 454-2273

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
DenturistGroup: 193400000X SINGLE SPECIALTY GROUP 122400000X DN00000367 WA Primary

Addresses

Primary practice location

210 S 11TH Ave
Suite #45
Yakima, WA 98902-3293

Mailing address

210 S 11TH Ave
Suite #45
Yakima, WA 98902-3293
Phone (509) 454-2273

Other identifiers 2

IdentifierTypeStateIssuer
5048293MedicaidWA
DN00000367OtherWALICENSE #

Other names 1

  • Disantis Prosthetics Former legal business name

National Provider Directory

National Provider Directory

Locations

210 S 11th Ave
Ste 45
Yakima, WA 98902
Phone (509) 454-2273

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": "1167264000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1922164557",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "210 S 11TH AVE",
            "address_2": "SUITE #45",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023293",
            "telephone_number": "509-454-2273",
            "fax_number": "509-454-7901"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S 11TH AVE",
            "address_2": "SUITE #45",
            "city": "YAKIMA",
            "state": "WA",
            "postal_code": "989023293",
            "telephone_number": "509-454-2273",
            "fax_number": "509-454-7901"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IVORY DENTURE CARE, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-12-28",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "DISANTIS",
        "authorized_official_first_name": "WILLIAM",
        "authorized_official_middle_name": "S.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "509-454-2273",
        "authorized_official_credential": "D.D."
    },
    "taxonomies": [
        {
            "code": "122400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Denturist",
            "state": "WA",
            "license": "DN00000367",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5048293",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "DN00000367",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Disantis Prosthetics",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

Other providers in Yakima, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.