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NPI Code Detail

MEDICARE: IDEAL DENTAL OF UPTOWN

MEDICARE: IDEAL DENTAL OF UPTOWN
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
11223G0001XGeneral Practice DentistryTX

General Provider Information

NPI Number : 1629342241
Entity Type Code : Organization
Provider Name (Legal Business Name) : IDEAL DENTAL OF UPTOWN
Provider Business Mailing Address
First Line : 4323 LEMMON AVE
Second Line :
City : DALLAS
State : TX
Zip : 75219-2706
Country : US
Telephone Number : 214-522-4444
Fax Number :
Provider Business Practice Location Address
First Line : 4323 LEMMON AVE
Second Line :
City : DALLAS
State : TX
Zip : 75219-2706
Country : US
Telephone Number : 214-522-4444
Fax Number :
Authorized Official
Title or Position : PARTNER
Name : DR. RODNEY N ALLES JR.
Credential : DDS
Telephone Number : 214-727-8171
Provider Enumeration Date : 02/29/2012
Last Update Date : 02/29/2012

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Directions to “IDEAL DENTAL OF UPTOWN ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.