Provider Demographics
NPI:1194351510
Name:TD DREAMWORKS PLLC
Entity type:Organization
Organization Name:TD DREAMWORKS PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANH
Authorized Official - Middle Name:CONG
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:228-215-3003
Mailing Address - Street 1:2996 BIENVILLE BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-4303
Mailing Address - Country:US
Mailing Address - Phone:228-215-3003
Mailing Address - Fax:
Practice Address - Street 1:2996 BIENVILLE BLVD STE A
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-4303
Practice Address - Country:US
Practice Address - Phone:504-605-5850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-03-17
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental