Organization Name: | DAVID M IVEY DDS PC |
NPI Number: | 1912019290 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | DAVID M IVEY (PRESIDENT) |
Mailing Address: | One Mid Rivers Mall Dr Ste 310 St Peters |
State: | MO US |
Postal Code: | 633764323 |
Phone Number: | 6369287217 |
Fax Number: | 6363971137 |
NPI Enumeration Date: | 08/31/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204E00000X |
License Number: | 012332 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | MO |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Oral & Maxillofacial Surgery |
Taxonomy Specialization: | |
Taxonomy Definition: |