Provider Demographics
NPI:1194328179
Name:DREAM DENTAL OF BRENHAM LLC
Entity type:Organization
Organization Name:DREAM DENTAL OF BRENHAM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAJESH
Authorized Official - Middle Name:
Authorized Official - Last Name:DHANANI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:201-920-7419
Mailing Address - Street 1:639 MEDICAL PKWY
Mailing Address - Street 2:
Mailing Address - City:BRENHAM
Mailing Address - State:TX
Mailing Address - Zip Code:77833-5412
Mailing Address - Country:US
Mailing Address - Phone:979-836-5236
Mailing Address - Fax:409-227-0257
Practice Address - Street 1:639 MEDICAL PKWY
Practice Address - Street 2:
Practice Address - City:BRENHAM
Practice Address - State:TX
Practice Address - Zip Code:77833-5412
Practice Address - Country:US
Practice Address - Phone:979-836-5236
Practice Address - Fax:409-227-0257
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-20
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty