Provider Demographics
NPI:1902542129
Name:UM DENTAL INC
Entity Type:Organization
Organization Name:UM DENTAL INC
Other - Org Name:IVY ENDOTONTIC GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:JUNGHYUN
Authorized Official - Last Name:UM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-530-7888
Mailing Address - Street 1:12865 MAIN ST STE 201
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-8200
Mailing Address - Country:US
Mailing Address - Phone:714-530-7888
Mailing Address - Fax:714-530-1344
Practice Address - Street 1:12865 MAIN ST STE 201
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92840-8200
Practice Address - Country:US
Practice Address - Phone:714-530-7888
Practice Address - Fax:714-530-1344
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-10
Last Update Date:2022-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental