Provider Demographics
NPI:1992356919
Name:IDEAL SMILES ENTERPRISE, INC
Entity Type:Organization
Organization Name:IDEAL SMILES ENTERPRISE, INC
Other - Org Name:IDEAL SMILES DENTAL CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MIKE
Authorized Official - Middle Name:
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:954-933-1705
Mailing Address - Street 1:6536 N. UNIVERSITY DR.
Mailing Address - Street 2:
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321
Mailing Address - Country:US
Mailing Address - Phone:954-933-1705
Mailing Address - Fax:954-532-5375
Practice Address - Street 1:6536 N. UNIVERSITY DRIVE
Practice Address - Street 2:
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321
Practice Address - Country:US
Practice Address - Phone:954-933-1705
Practice Address - Fax:954-532-5375
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-20
Last Update Date:2021-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDentalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1891175717Medicaid