| NPI | 1457828493 |
|---|---|
| Doing Business As | IVY ROSE MANSFIELD |
| Entity Type | Organization |
| Authorized Contact | ASHLY SUNSHINE Credentialing Specialist 636-362-4986 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 122300000X Dentist |
| Enumeration Date | 2018-10-29 |
| Last Update Date | 2023-01-26 |