Provider Demographics
NPI:1023482999
Name:IDEAL DENTAL OF CLEARLAKE PLLC
Entity type:Organization
Organization Name:IDEAL DENTAL OF CLEARLAKE 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:281-990-0677
Mailing Address - Street 1:3535 CLEAR LAKE CITY BOULEVARD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77059
Mailing Address - Country:US
Mailing Address - Phone:281-990-0677
Mailing Address - Fax:
Practice Address - Street 1:3535 CLEAR LAKE CITY BOULEVARD
Practice Address - Street 2:SUITE 400
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77059
Practice Address - Country:US
Practice Address - Phone:281-990-0677
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-16
Last Update Date:2016-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty