# IDEAL DENTAL OF ALAMO RANCH PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Ideal Dental of Alamo Ranch
- **Organization subpart:** No

## Provider details

- **NPI number:** 1114411089
- **Authorized official:** CAROL CANAVA (INSURANCE MANAGER)
- **Authorized official phone:** (972) 361-0600

## Contact information

- **Practice address:** 12007 ALAMO RANCH PKWY, STE 122, SAN ANTONIO, TX 78253
- **Practice address phone:** (210) 504-2953
- **Mailing address:** PO BOX 840925, DALLAS, TX 75284-1438
- **Mailing address phone:** (972) 331-8079

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | — | Yes |

## Other

- **Enumeration date:** 06/14/2018
- **Last updated:** 01/02/2020