Provider Demographics
NPI:1962823237
Name:IDEAL DENTAL OF HIGHLAND VILLAGE, PLLC
Entity type:Organization
Organization Name:IDEAL DENTAL OF HIGHLAND VILLAGE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALLES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:972-361-0600
Mailing Address - Street 1:3651 JUSTIN ROAD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028
Mailing Address - Country:US
Mailing Address - Phone:972-361-0600
Mailing Address - Fax:
Practice Address - Street 1:3651 JUSTIN ROAD
Practice Address - Street 2:SUITE 130
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028
Practice Address - Country:US
Practice Address - Phone:972-361-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-03
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty