Ideal Dental of University Park, PLLC

Key facts

NPI

1972885291

Entity type

Organization (NPI type 2)

Primary specialty

General Practice Dentistry 1223G0001X

License

22290 (TX)

Legal business name

IDEAL DENTAL OF UNIVERSITY PARK, PLLC

Practice address

8611 Hillcrest Ave
Suite 250
Dallas, TX 75225-4207

Phone

(214) 361-3550

NPI assigned

Sep 13, 2011

Organization subpart

No

Authorized official

Name

Carol L Cantu

Title

Insurance Specialist

Phone

(817) 571-3368

National Provider Directory

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Sep 13, 2011.

{
    "created_epoch": "1315872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1315872000000",
    "number": "1972885291",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8611 HILLCREST AVE",
            "address_2": "SUITE 250",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752254207",
            "telephone_number": "214-361-3550"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8611 HILLCREST AVE",
            "address_2": "SUITE 250",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752254207",
            "telephone_number": "214-361-3550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "IDEAL DENTAL OF UNIVERSITY PARK, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-09-13",
        "last_updated": "2011-09-13",
        "status": "A",
        "authorized_official_last_name": "CANTU",
        "authorized_official_first_name": "CAROL",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "INSURANCE SPECIALIST",
        "authorized_official_telephone_number": "817-571-3368"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "TX",
            "license": "22290",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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