Ideal Dental of Roanoke PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

IDEAL DENTAL OF ROANOKE PLLC

Practice address

860 East Highway 114
Suite 200
Roanoke, TX 76262

Phone

(817) 491-3000

NPI assigned

May 20, 2015

Last updated

Oct 8, 2024By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Shalin Patel, DMD

Title

Owner

Phone

(972) 331-8067

Specialties & licenses 1

Addresses

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Fatima Naurose Siraj, D.M.D

  • Dentist
  • Roanoke, TX
  • NPI 1942683115
  NPD (past)
• Radwan Monzer Tassabhji, DMD

  • Dentist
  • Roanoke, TX
  • NPI 1144152067
  NPD (past)

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

{
    "created_epoch": "1432080000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1728345600000",
    "number": "1306225529",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "860 EAST HIGHWAY 114",
            "address_2": "SUITE 200",
            "city": "ROANOKE",
            "state": "TX",
            "postal_code": "76262",
            "telephone_number": "817-491-3000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "860 EAST HIGHWAY 114",
            "address_2": "SUITE 200",
            "city": "ROANOKE",
            "state": "TX",
            "postal_code": "76262",
            "telephone_number": "817-491-3000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL DENTAL OF ROANOKE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-05-20",
        "last_updated": "2024-10-08",
        "certification_date": "2024-10-08",
        "status": "A",
        "authorized_official_last_name": "PATEL",
        "authorized_official_first_name": "SHALIN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "972-331-8067",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Kerry B Howell, LPC-S
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• Kathleen Leontine Jessen, OTR/L, IBCLC
• Renata Antunes Joffe, MD
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• Dentist in Roanoke, TX
• Providers in Roanoke, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2024; 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.