Ideal Dental of Lake Nona PLLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

IDEAL DENTAL OF LAKE NONA PLLC

Practice address

12851 Narcoossee Rd Ste 102
Orlando, FL 32832-7156

Phone

(407) 749-1560

Fax

(407) 550-6210

NPI assigned

Aug 17, 2020

Organization subpart

No

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

Authorized official

Name

Joshua Coussa, DMD

Title

Owner

Phone

(972) 331-8079

Specialties & licenses 1

Addresses

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mai Eltantawy, DMD

  • General Practice Dentistry
  • Orlando, FL
  • NPI 1144901463
  NPD
• Faraz Nabi Memon, DMD

  • General Practice Dentistry
  • Orlando, FL
  • NPI 1225505704
  NPD
• Andrea Carolina Castillo Armas, DMD

  • General Practice Dentistry
  • Orlando, FL
  • NPI 1174217921
  NPD (past)

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

{
    "created_epoch": "1597622400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696204800000",
    "number": "1821609454",
    "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": "12851 NARCOOSSEE RD STE 102",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328327156",
            "telephone_number": "407-749-1560",
            "fax_number": "407-550-6210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL DENTAL OF LAKE NONA PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-08-17",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A",
        "authorized_official_last_name": "COUSSA",
        "authorized_official_first_name": "JOSHUA",
        "authorized_official_title_or_position": "OWNER",
        "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": []
}

• Ideal Braces, PA
• Ideal Care Alf
• Ideal Chiropractic & Body Contour LLC
• Ideal Dental - Millenia PLLC
• Ideal Dental Group of Orlando
• Ideal Dental of Lee Vista
• Ideal Dental of Lee Vista PLLC
• Ideal Dental of University Pointe PLLC
• Ideal Hormone
• Nadia Ideis

• Dentist in Orlando, FL
• Providers in Orlando, FL by specialty
• Dentist in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 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.