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NPI Code Detail

MEDICARE: IDEAL DENTAL OF WESTCHASE FLORIDA PLLC

MEDICARE: IDEAL DENTAL OF WESTCHASE FLORIDA PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist

General Provider Information

NPI Number : 1467028928
Entity Type Code : Organization
Provider Name (Legal Business Name) : IDEAL DENTAL OF WESTCHASE FLORIDA PLLC
Provider Business Mailing Address
First Line : PO BOX 840925
Second Line :
City : DALLAS
State : TX
Zip : 75284-0925
Country : US
Telephone Number : 972-361-0600
Fax Number :
Provider Business Practice Location Address
First Line : 10641 SHELDON RD
Second Line :
City : TAMPA
State : FL
Zip : 33626-5114
Country : US
Telephone Number : 813-849-0003
Fax Number : 813-692-3592
Authorized Official
Title or Position : OWNER
Name : MATTHEW DOAN
Credential : DDS
Telephone Number : 972-331-8073
Provider Enumeration Date : 06/03/2021
Last Update Date : 10/02/2023

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Directions to “IDEAL DENTAL OF WESTCHASE FLORIDA PLLC ” Practice Location

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