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General NPI Number Information
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NPI Number | 1245805274
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Entity Type | Organization
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Legal Business Name | IDEAL SMILES INC
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Dates
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Enumeration Date | 05/21/2021
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Last Update Date | 10/11/2022
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Provider Practice Location Address
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Address Line | 6779 TAFT ST
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City | HOLLYWOOD
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State | FL
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Zip | 33024-3902
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Country | US
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Telephone | 954-639-9900
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Fax |
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Provider Business Mailing Address
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Address Line | 6779 TAFT ST
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City | HOLLYWOOD
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State | FL
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Zip | 33024-3902
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Country | US
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Telephone | 954-639-9900
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Fax |
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Authorized Official
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Title or Position | OWNER/PRESIDENT
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Name | DR. MIKE HOANG
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Credential | DDS
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Telephone | 954-639-9900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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