NPIMap

Organization Active NPI

Ideal Dental of Lee Vista

  • Dentist
  • Orlando, FL
National Provider Identifier
1083203632
Registry record updated Mar 22, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
Legal business name
IDEAL DENTAL OF LEE VISTA
Practice address
6784 Eagle Watch Dr Ste 550
Orlando, FL 32822-2355
Phone
(407) 982-7996
NPI assigned
Jan 18, 2021
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 22, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Joshua Coussa, DMD
Title
Owner
Phone
(407) 982-7996

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
DentistGroup: 193400000X SINGLE SPECIALTY GROUP 122300000X Primary

Addresses

Primary practice location

6784 Eagle Watch Dr Ste 550
Orlando, FL 32822-2355

Mailing address

PO Box 840925
Dallas, TX 75284-0925
Phone (972) 361-0600

National Provider Directory

National Provider Directory
Tax ID family
Ideal Dental of Lee Vista2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 5

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1610928000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1647907200000",
    "number": "1083203632",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 840925",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752840925",
            "telephone_number": "972-361-0600"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6784 EAGLE WATCH DR STE 550",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328222355",
            "telephone_number": "407-982-7996"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL DENTAL OF LEE VISTA",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-01-18",
        "last_updated": "2022-03-22",
        "certification_date": "2022-03-22",
        "status": "A",
        "authorized_official_last_name": "COUSSA",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "407-982-7996",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Orlando, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.