Provider Demographics
NPI:1629342241
Name:IDEAL DENTAL OF UPTOWN
Entity Type:Organization
Organization Name:IDEAL DENTAL OF UPTOWN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RODNEY
Authorized Official - Middle Name:N
Authorized Official - Last Name:ALLES
Authorized Official - Suffix:JR
Authorized Official - Credentials:DDS
Authorized Official - Phone:214-727-8171
Mailing Address - Street 1:4323 LEMMON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75219-2706
Mailing Address - Country:US
Mailing Address - Phone:214-522-4444
Mailing Address - Fax:
Practice Address - Street 1:4323 LEMMON AVE
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75219-2706
Practice Address - Country:US
Practice Address - Phone:214-522-4444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-29
Last Update Date:2012-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty