Provider Demographics
NPI:1063934115
Name:IDEAL DENTAL, INC.
Entity type:Organization
Organization Name:IDEAL DENTAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAGIN
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRERAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-771-0874
Mailing Address - Street 1:8603 S DIXIE HWY STE 411
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-1196
Mailing Address - Country:US
Mailing Address - Phone:305-771-0874
Mailing Address - Fax:
Practice Address - Street 1:8603 S DIXIE HWY STE 411
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-1196
Practice Address - Country:US
Practice Address - Phone:305-771-0874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-11
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty