| NPI | 1417384793 |
|---|---|
| Doing Business As | IVORY DENTAL SPECIALIST LLC |
| Entity Type | Organization |
| Authorized Contact | BONCIEL GRIFFIN Orthodontist/Owner 773-239-7696 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: IL 019025726) |
| Additional Taxonomies | 1223X0400X Dentist Orthodontics and Dentofacial Orthopedics (Licence: IL 021002361) |
| Enumeration Date | 2013-10-02 |
| Last Update Date | 2013-10-02 |