Ideal Dental Temple Terrace PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

IDEAL DENTAL TEMPLE TERRACE PLLC

Practice address

100 Bullard Parkway
Temple Terrace, FL 33617

Phone

(813) 849-0005

NPI assigned

Oct 18, 2021

Organization subpart

No

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

Authorized official

Name

Matthew Doan, DMD

Title

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": "1634515200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683504000000",
    "number": "1255094181",
    "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": "100 BULLARD PARKWAY",
            "city": "TEMPLE TERRACE",
            "state": "FL",
            "postal_code": "33617",
            "telephone_number": "813-849-0005"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL DENTAL TEMPLE TERRACE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-18",
        "last_updated": "2023-05-08",
        "certification_date": "2023-05-08",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "MATTHEW",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-361-0600",
        "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": []
}

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• Dentist in Temple Terrace, FL
• Providers in Temple Terrace, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2023; 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.