Organization
IDEAL DENTAL OF LAKE NONA PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSHUA COUSSA DMD (OWNER)
(972) 331-8079
Entity
Organization
Contact information
Practice address
12851 NARCOOSSEE RD STE 102, ORLANDO, FL 32832-7156
(407) 749-1560
(407) 550-6210
Mailing address
PO BOX 840925, DALLAS, TX 75284-0925
(972) 361-0600
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
—
—
Other
Enumeration date
08/17/2020
Last updated
10/02/2023
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