# IDEAL DENTAL ST CLOUD PLLC

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

## Provider details

- **NPI number:** 1477253730
- **Authorized official:** MATTHEW DOAN DMD (OWNER)
- **Authorized official phone:** (972) 331-8079

## Contact information

- **Practice address:** 2721 E IRLO BRONSON MEMORIAL HWY, KISSIMMEE, FL 34744-5602
- **Practice address phone:** (407) 556-6113
- **Mailing address:** PO BOX 840925, DALLAS, TX 75284-0925
- **Mailing address phone:** (972) 361-0600

## Taxonomy

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

## Other

- **Enumeration date:** 03/06/2023
- **Last updated:** 05/19/2023