Provider Demographics
NPI:1861905473
Name:IVY DENTAL CARE, PLLC
Entity type:Organization
Organization Name:IVY DENTAL CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:UZMA
Authorized Official - Middle Name:
Authorized Official - Last Name:HASHEEM
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:210-672-3737
Mailing Address - Street 1:7915 W LOOP 1604 N STE 119
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78254-4661
Mailing Address - Country:US
Mailing Address - Phone:210-672-3737
Mailing Address - Fax:210-672-3738
Practice Address - Street 1:7915 W LOOP 1604 N STE 119
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78254-4661
Practice Address - Country:US
Practice Address - Phone:210-672-3737
Practice Address - Fax:210-672-3738
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IVY DENTAL CARE, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-11-06
Last Update Date:2017-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31852261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3726879Medicaid