Idealsmile

Primary specialty

Dental Clinic/CenterTaxonomy code 261QD0000X

License

DN013040 Issued in GA

Legal business name

IDEALSMILE

Practice address

2501 Whittlesey Blvd
Suite B
Columbus, GA 31909-3031

Phone

(706) 257-7374

Fax

(706) 257-7379

NPI assigned

Oct 28, 2008

Last updated

Oct 28, 2008By 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

Dr. Jae H Ham, DDS

Title

President

Phone

(706) 257-7374

Specialties & licenses 1

Addresses

Other identifiers 2

Locations

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

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1225152000000",
    "number": "1710130455",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2501 WHITTLESEY BLVD",
            "address_2": "SUITE B",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319093031",
            "telephone_number": "706-257-7374",
            "fax_number": "706-257-7379"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2501 WHITTLESEY BLVD",
            "address_2": "SUITE B",
            "city": "COLUMBUS",
            "state": "GA",
            "postal_code": "319093031",
            "telephone_number": "706-257-7374",
            "fax_number": "706-257-7379"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEALSMILE",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-28",
        "last_updated": "2008-10-28",
        "status": "A",
        "authorized_official_last_name": "HAM",
        "authorized_official_first_name": "JAE",
        "authorized_official_middle_name": "H",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "706-257-7374",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "GA",
            "license": "DN013040",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "561235509C",
            "state": "GA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "626075029C",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zoey Hypes
• I Basilio MD, PC
• Aiwane Iboaya, D.O
• Akram Ibrahim, MD
• Ideal Smile Dentistry LLC
• Daniel Ikeagu
• Anne Lyle Illges, OTR/L
• Illuminating Behavior Solutions LLC (Illuminating Behavior)
• Independent Physical Therapy of Ga LLC
• Independent Physical Therapy of Ga, LLC

• Dental Clinic/Center in Columbus, GA
• Providers in Columbus, GA by specialty
• Dental Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 28, 2008; 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.