Specialty |
Taxonomy Code | Specialty Code | Provider Type | |
Oral & Maxillofacial Surgery |
204E00000X | 02 | Physician/General Surgery |
| NPI Number | 1336631035 |
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| LBN Legal business name | MICHAEL Y IVRY DDS PC | ||||||||
| Authorized official | MICHAEL IVRY - (OWNER) | ||||||||
| Entity | Organization | ||||||||
| Organization subpart 1 | No | ||||||||
| Enumeration date | 05/30/2018 | ||||||||
| Last updated | 05/30/2018 - About 8 years ago | ||||||||
| Identifiers |
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