Provider Demographics
NPI:1760064521
Name:IDEAL SMILES PLANTATION, INC.
Entity Type:Organization
Organization Name:IDEAL SMILES PLANTATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:APRIL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-687-0031
Mailing Address - Street 1:12235 W SUNRISE BLVD
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33323-2234
Mailing Address - Country:US
Mailing Address - Phone:954-687-0031
Mailing Address - Fax:954-372-0031
Practice Address - Street 1:12235 W SUNRISE BLVD
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33323-2234
Practice Address - Country:US
Practice Address - Phone:954-687-0031
Practice Address - Fax:954-372-0031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-22
Last Update Date:2021-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty