Ivory Lane LLC

NPI #1356047369 in Scottsdale, Arizona

Provider Information

NPI Number: 1356047369
Entity Type: Organization
Organization Name: Ivory Lane LLC
Primary Specialty: Dentist
Enumeration Date: Feb 1, 2023
Last Updated: Feb 1, 2023

Practice Location

Address: 8609 E CLYDESDALE TRL
City: Scottsdale
State: Arizona
ZIP Code: 85258-1456
Phone: (775) 771-2197

Authorized Official

Name: STEPHANIE PAGELS, DDS
Title: DENTIST
Phone: (775) 771-2197

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Dentist	122300000X	Primary

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