NPI 1063792752

Ivy Dental

Organisation General Practice Dentistry Shreveport, LA

Practice location

Address: 460 Ashley Ridge Blvd STE 600, Shreveport, LA 71106-7238
Phone: (318) 868-4188
Fax: (318) 868-9151

Authorised official

Name: Andretta Rrenee Porter-Williams
Title: Owner
Phone: (318) 868-4188

Registered specialties

General Practice Dentistry Primary

Dental Providers Taxonomy 1223G0001X Licence 4645 (LA)

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Registry record

NPI: 1063792752
Entity type: Organization
NPI issued: 25 Aug 2011
Record last updated: 25 Aug 2011

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.