Provider Demographics
NPI:1720586944
Name:IDEAL DENTAL CLINICAL OPERATIONS
Entity Type:Organization
Organization Name:IDEAL DENTAL CLINICAL OPERATIONS
Other - Org Name:AURORA DENTAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSE
Authorized Official - Middle Name:L
Authorized Official - Last Name:YABER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:305-667-1131
Mailing Address - Street 1:8603 S DIXIE HWY STE 411
Mailing Address - Street 2:
Mailing Address - City:PINECREST
Mailing Address - State:FL
Mailing Address - Zip Code:33156-1196
Mailing Address - Country:US
Mailing Address - Phone:305-771-0874
Mailing Address - Fax:
Practice Address - Street 1:8603 S DIXIE HWY STE 411
Practice Address - Street 2:
Practice Address - City:PINECREST
Practice Address - State:FL
Practice Address - Zip Code:33156-1196
Practice Address - Country:US
Practice Address - Phone:305-771-0874
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-23
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty