Ideal Dental of Southlake, PLLC

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

Legal business name

IDEAL DENTAL OF SOUTHLAKE, PLLC

Practice address

2645 E Southlake Blvd
Suite 150
Southlake, TX 76092

Phone

(817) 734-9445

NPI assigned

Jul 12, 2013

Organization subpart

No

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

Authorized official

Name

Dr. Rodney Alles, DDS

Title

Co-Owner

Phone

(972) 361-0600

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1373587200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1373587200000",
    "number": "1245671742",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2645 E SOUTHLAKE BLVD",
            "address_2": "SUITE 150",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "76092",
            "telephone_number": "817-734-9445"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2645 E SOUTHLAKE BLVD",
            "address_2": "SUITE 150",
            "city": "SOUTHLAKE",
            "state": "TX",
            "postal_code": "76092",
            "telephone_number": "817-734-9445"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL DENTAL OF SOUTHLAKE, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-07-12",
        "last_updated": "2013-07-12",
        "status": "A",
        "authorized_official_last_name": "ALLES",
        "authorized_official_first_name": "RODNEY",
        "authorized_official_title_or_position": "CO-OWNER",
        "authorized_official_telephone_number": "972-361-0600",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• General Practice Dentistry in Southlake, TX
• Providers in Southlake, TX by specialty
• General Practice Dentistry in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 12, 2013; 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.