Provider Demographics
NPI:1083854038
Name:DREAMWORKS DENTAL PA
Entity type:Organization
Organization Name:DREAMWORKS DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-608-9984
Mailing Address - Street 1:2000 ESTERS RD
Mailing Address - Street 2:SUITE #100
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75061-9531
Mailing Address - Country:US
Mailing Address - Phone:972-871-9800
Mailing Address - Fax:972-871-9802
Practice Address - Street 1:2000 ESTERS RD
Practice Address - Street 2:SUITE #100
Practice Address - City:IRVING
Practice Address - State:TX
Practice Address - Zip Code:75061-9531
Practice Address - Country:US
Practice Address - Phone:972-906-5550
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-04
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX239991223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty