Provider Demographics
NPI:1467574871
Name:IDEAL DENTAL CARE
Entity Type:Organization
Organization Name:IDEAL DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PANAGIOTIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GLAVAS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:516-487-6453
Mailing Address - Street 1:800 NORTHERN BOULEVARD
Mailing Address - Street 2:SUITE #6
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021
Mailing Address - Country:US
Mailing Address - Phone:516-487-6453
Mailing Address - Fax:
Practice Address - Street 1:800 NORTHERN BOULEVARD
Practice Address - Street 2:SUITE #6
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021
Practice Address - Country:US
Practice Address - Phone:516-487-6453
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-05
Last Update Date:2010-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047563122300000X, 1223G0001X, 1223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223P0700XDental ProvidersDentistProsthodonticsGroup - Multi-Specialty