Provider Demographics
NPI:1679104079
Name:IDEAL SMILES DENTAL CARE
Entity Type:Organization
Organization Name:IDEAL SMILES DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:XUE
Authorized Official - Middle Name:
Authorized Official - Last Name:DU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:323-873-6690
Mailing Address - Street 1:15613 BEL RED RD STE C
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-2348
Mailing Address - Country:US
Mailing Address - Phone:425-869-7560
Mailing Address - Fax:425-869-7699
Practice Address - Street 1:15613 BEL RED RD STE C
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98008-2348
Practice Address - Country:US
Practice Address - Phone:425-869-7560
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty