Ideal Dental Northwest Oklahoma City

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

IDEAL DENTAL NORTHWEST OKLAHOMA CITY

Practice address

3629 NW 178TH Street
Ste D
Oklahoma City, OK 73012

Phone

(972) 361-0600

NPI assigned

Jun 12, 2025

Organization subpart

No

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

Authorized official

Name

Carol Canava

Title

VP Revenue Cycle

Phone

(972) 331-8079

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1749686400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1749686400000",
    "number": "1366337966",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12750 MERIT DR STE 1100",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752511302"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3629 NW 178TH STREET",
            "address_2": "STE D",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73012",
            "telephone_number": "972-361-0600"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL DENTAL NORTHWEST OKLAHOMA CITY",
        "organizational_subpart": "NO",
        "enumeration_date": "2025-06-12",
        "last_updated": "2025-06-12",
        "certification_date": "2025-05-27",
        "status": "A",
        "authorized_official_last_name": "CANAVA",
        "authorized_official_first_name": "CAROL",
        "authorized_official_title_or_position": "VP REVENUE CYCLE",
        "authorized_official_telephone_number": "972-331-8079"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• James Paul Ice, MD
• Rebekah Diane Ice, OTR/L
• Francis Idada, M.D
• Idcokc PLLC
• Aysha Z Iddeen-Wade
• Idental PLLC
• Chase Te Idleman, RDH
• George Clayton Idlett
• Jennifer Dawn Idlett
• Ifeoluwa Ochuwa Idode

• Dentist in Oklahoma City, OK
• Providers in Oklahoma City, OK by specialty
• Dentist in Oklahoma

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 12, 2025; 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.