Provider Demographics
NPI:1780045849
Name:IDEAL DENTAL CARE , INC
Entity Type:Organization
Organization Name:IDEAL DENTAL CARE , INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:ABUHAJLEH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:781-254-2626
Mailing Address - Street 1:8111 MIDLOTHIAN TPKE
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-5115
Mailing Address - Country:US
Mailing Address - Phone:804-918-9667
Mailing Address - Fax:804-918-9652
Practice Address - Street 1:8111 MIDLOTHIAN TPKE
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-5115
Practice Address - Country:US
Practice Address - Phone:804-918-9667
Practice Address - Fax:804-918-9652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401412655305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization