MEDICARE: IDEAL DENTAL, INC.

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	122300000X	Dentist
2	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1063934115
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL DENTAL, INC.

Provider Business Mailing Address
First Line	:	4868 SW 72ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-5526
Country	:	US
Telephone Number	:	305-771-0874
Fax Number	:

Provider Business Practice Location Address
First Line	:	4868 SW 72ND AVE
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33155-5526
Country	:	US
Telephone Number	:	305-771-0874
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MAGIN CARRERAS
Credential	:
Telephone Number	:	305-771-0874

Provider Enumeration Date	:	07/11/2017
Last Update Date	:	12/02/2025

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Directions to “IDEAL DENTAL, INC. ” Practice Location

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