Ideal Dental - Jacksonville Beach

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

IDEAL DENTAL - JACKSONVILLE BEACH

Practice address

2218 3Rd St S
Jacksonville Beach, FL 32250-4021

Phone

(904) 441-0632

Fax

(904) 747-4156

NPI assigned

Oct 1, 2021

Organization subpart

No

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

Authorized official

Name

Matthew Doan, 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.

• Madison Gatewood, DMD

  • General Practice Dentistry
  • Jacksonville Beach, FL
  • NPI 1477244804
  NPD
• Suvana Hashim, DDS

  • General Practice Dentistry
  • Jacksonville Beach, FL
  • NPI 1447684493
  NPD
• Kevin Tran, DMD

  • Dentist
  • Jacksonville Beach, FL
  • NPI 1649108887
  NPD (past)

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

{
    "created_epoch": "1633046400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696204800000",
    "number": "1912679580",
    "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": "2218 3RD ST S",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322504021",
            "telephone_number": "904-441-0632",
            "fax_number": "904-747-4156"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL DENTAL - JACKSONVILLE BEACH",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-01",
        "last_updated": "2023-10-02",
        "certification_date": "2023-10-02",
        "status": "A",
        "authorized_official_last_name": "DOAN",
        "authorized_official_first_name": "MATTHEW",
        "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": []
}

• Katie Carlson Howard, CCC-SLP
• Michael Hubbard
• Brian Hunt
• Ajla Hurem, ARNP
• Michael B Ibach, M.D.
• Im Sulzbacher Center for the Homeless Inc (Beaches Community Healthcare)
• In the Pink Boutique, Inc. (In the Pink)
• In the Pink Boutique, Inc.
• Infinity Health Systems Inc
• Infinity Health Systems Inc (Donald W. Lowery, D.C.)

• Dentist in Jacksonville Beach, FL
• Providers in Jacksonville Beach, 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.