Healthcare Provider Details

I. General information

NPI: 1568394823
Provider Name (Legal Business Name): IDEAL DENTAL POMPANO BEACH PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 06/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3329 N FEDERAL HWY BAY 8
POMPANO BEACH FL
33064-6741
US

IV. Provider business mailing address

PO BOX 840925
DALLAS TX
75284-0925
US

V. Phone/Fax

Practice location:
  • Phone: 954-323-8334
  • Fax:
Mailing address:
  • Phone: 972-333-1582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: MATTHEW DOAN
Title or Position: OWNER
Credential:
Phone: 972-333-1582