Provider Demographics
NPI:1063861128
Name:IDEAL DENTAL OF CYPRESS PLLC
Entity Type:Organization
Organization Name:IDEAL DENTAL OF CYPRESS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SULMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-361-0600
Mailing Address - Street 1:9822 FRY RD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:CYPRESS
Mailing Address - State:TX
Mailing Address - Zip Code:77433-5370
Mailing Address - Country:US
Mailing Address - Phone:281-204-2747
Mailing Address - Fax:
Practice Address - Street 1:9822 FRY RD
Practice Address - Street 2:SUITE 140
Practice Address - City:CYPRESS
Practice Address - State:TX
Practice Address - Zip Code:77433-5370
Practice Address - Country:US
Practice Address - Phone:281-204-2747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-09
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty