Provider Demographics
NPI:1922467760
Name:IDEAL DENTAL BRUSH CEDAR PARK PLLC
Entity Type:Organization
Organization Name:IDEAL DENTAL BRUSH CEDAR PARK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SULMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AHMED
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:972-361-0600
Mailing Address - Street 1:1201 N BELL BLVD
Mailing Address - Street 2:
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613-7018
Mailing Address - Country:US
Mailing Address - Phone:972-361-0600
Mailing Address - Fax:
Practice Address - Street 1:1201 N BELL BLVD
Practice Address - Street 2:
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613-7018
Practice Address - Country:US
Practice Address - Phone:512-462-3232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-22
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty