| Ivory Dental | |
|
12624 S Route 59 Plainfield IL 60585-5448 | |
| (815) 577-0900 | |
| (815) 577-6331 |
| Full Name | Ivory Dental |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 12624 S Route 59, Plainfield, Illinois |
| Authorized Official Name and Position | Shefali Patel (OWNER) |
| Authorized Official Contact | 8155770900 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ivory Dental 12624 S Route 59 Plainfield IL 60585-5448 Ph: (815) 577-0900 | Ivory Dental 12624 S Route 59 Plainfield IL 60585-5448 Ph: (815) 577-0900 |
| NPI Number | 1124549399 |
|---|---|
| Provider Enumeration Date | 06/28/2017 |
| Last Update Date | 07/21/2022 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1124549399 | NPI | - | NPPES |
| 1043387707 | Other | IL | TYPE I |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 019025824 (Illinois) | Primary |
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