MEDICARE: IDEAL DENTAL INDIAN LAND PC

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

General Provider Information

NPI Number	:	1629873898
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IDEAL DENTAL INDIAN LAND PC

Provider Business Mailing Address
First Line	:	PO BOX 840925
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-0925
Country	:	US
Telephone Number	:	972-361-0600
Fax Number	:

Provider Business Practice Location Address
First Line	:	2089 PARKWAY DR STE 102
Second Line	:
City	:	INDIAN LAND
State	:	SC
Zip	:	29707-8089
Country	:	US
Telephone Number	:	803-829-0119
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	DR. MATTHEW DDOAN
Credential	:	DDS
Telephone Number	:	803-829-0119

Provider Enumeration Date	:	02/13/2025
Last Update Date	:	02/13/2025

Similar Medicare Providers

1427981448 — DR. CHAU LE DDS
Practice Location Address:

2089 PARKWAY DR STE 102
INDIAN LAND, SC
29707-8089

Practice Phone: 803-829-0119
Practice Fax:

1083928527 — GEROCARE CONSULTING LLC
Practice Location Address:

17332 GARDEN HEATH CT
LAND O LAKES, FL
34638-8089

Practice Phone: 813-412-3421
Practice Fax:

1023790581 — YELITZA CORREDOR
Practice Location Address:

17336 GARDEN HEATH CT
LAND O LAKES, FL
34638-8089

Practice Phone: 813-541-3364
Practice Fax:

1508529256 — CAROLINE RACQUEL WILLIAMS PT, DPT
Practice Location Address:

2816 WORLDREACH DR
INDIAN LAND, SC
29707-6571

Practice Phone: 803-548-0132
Practice Fax: 803-548-0134

1982212585 — ASHLEY SNIPES THOMAS APRN
Practice Location Address:

7697 CHARLOTTE HWY
INDIAN LAND, SC
29707-9653

Practice Phone: 866-389-2727
Practice Fax:

1336074061 — NICHOL MARGARET COBURN DDS
Practice Location Address:

8390 CHARLOTTE HWY STE 300
INDIAN LAND, SC
29707-6563

Practice Phone: 803-431-7477
Practice Fax:

Directions to “IDEAL DENTAL INDIAN LAND PC ” Practice Location

Language	Start Address	Practice Location

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.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.