| Ideal Dental Of Southlake, Pllc | |
|
2645 E Southlake Blvd Suite 150 Southlake TX 76092 | |
| (817) 734-9445 | |
| Not Available |
| Full Name | Ideal Dental Of Southlake, Pllc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 2645 E Southlake Blvd, Southlake, Texas |
| Authorized Official Name and Position | Rodney Alles (CO-OWNER) |
| Authorized Official Contact | 9723610600 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Ideal Dental Of Southlake, Pllc 2645 E Southlake Blvd Suite 150 Southlake TX 76092 Ph: (817) 734-9445 | Ideal Dental Of Southlake, Pllc 2645 E Southlake Blvd Suite 150 Southlake TX 76092 Ph: (817) 734-9445 |
| NPI Number | 1245671742 |
|---|---|
| Provider Enumeration Date | 07/12/2013 |
| Last Update Date | 07/12/2013 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245671742 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | (* (Not Available)) | Primary |
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