Provider Demographics
NPI:1841616661
Name:IDEAL DENTAL CARE PC
Entity Type:Organization
Organization Name:IDEAL DENTAL CARE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:YUSAF
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:607-425-8450
Mailing Address - Street 1:5376 FOREST TRAIL DR
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61109-6515
Mailing Address - Country:US
Mailing Address - Phone:607-425-8450
Mailing Address - Fax:
Practice Address - Street 1:5876 E STATE ST
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61108-2428
Practice Address - Country:US
Practice Address - Phone:607-425-8450
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-18
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027844261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental