# IDEAL DENTAL SOUTH JACKSONVILLE PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1255067179
- **Authorized official:** MATTHEW DOAN DMD (OWNER)
- **Authorized official phone:** (972) 331-8079

## Contact information

- **Practice address:** 5753 BEACH BOULEVARD, UNIT \#4, JACKSONVILLE, FL 32207
- **Practice address phone:** (904) 441-1642
- **Practice address fax:** (904) 877-3037
- **Mailing address:** PO BOX 840925, DALLAS, TX 75284-0925
- **Mailing address phone:** (972) 361-0600

## Taxonomy

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

## Other

- **Enumeration date:** 07/25/2022
- **Last updated:** 10/04/2023