MEDICARE: IDEAL DENTAL LLC

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
1	1223G0001X	General Practice Dentistry

General Provider Information

NPI Number	:	1659151066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL DENTAL LLC

Provider Business Mailing Address
First Line	:	1901 S EASTERN AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89104-3917
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2797 S MARYLAND PKWY STE 13
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-1576
Country	:	US
Telephone Number	:	702-998-9848
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	ABRIL PEREZ-LOYO
Credential	:
Telephone Number	:	702-266-3390

Provider Enumeration Date	:	10/03/2023
Last Update Date	:	10/03/2023

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Directions to “IDEAL DENTAL LLC ” Practice Location

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