Ideal Dental of Waterside PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

IDEAL DENTAL OF WATERSIDE PLLC

Practice address

5925 Convair Dr Ste F505
Ft Worth, TX 76109-1275

Phone

(817) 778-0418

NPI assigned

Nov 2, 2017

Organization subpart

No

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

Authorized official

Name

Sulman Ahmed, DMD

Title

Ceo

Phone

(972) 331-8079

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1509580800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683849600000",
    "number": "1629580394",
    "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"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5925 CONVAIR DR STE F505",
            "city": "FT WORTH",
            "state": "TX",
            "postal_code": "761091275",
            "telephone_number": "817-778-0418"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL DENTAL OF WATERSIDE PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-11-02",
        "last_updated": "2023-05-12",
        "certification_date": "2023-05-12",
        "status": "A",
        "authorized_official_last_name": "AHMED",
        "authorized_official_first_name": "SULMAN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "972-331-8079",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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