Provider Demographics
NPI:1225207517
Name:DENTAL DREAMS, LLC
Entity type:Organization
Organization Name:DENTAL DREAMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP MARKETING / COMPLIANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:TROY
Authorized Official - Middle Name:T
Authorized Official - Last Name:KLUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:920-838-1649
Mailing Address - Street 1:3033 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:ROXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02119-1227
Mailing Address - Country:US
Mailing Address - Phone:617-541-2200
Mailing Address - Fax:617-541-2206
Practice Address - Street 1:3033 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119-1227
Practice Address - Country:US
Practice Address - Phone:617-541-2200
Practice Address - Fax:617-541-2206
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21815122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty