Provider Demographics
NPI:1548053887
Name:DREAM TEAM FAMILY DENTISTRY AND ORAL SURGERY LEBANON
Entity type:Organization
Organization Name:DREAM TEAM FAMILY DENTISTRY AND ORAL SURGERY LEBANON
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:DRISCOLL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:615-895-3232
Mailing Address - Street 1:1430 W BADDOUR PKWY STE B
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:TN
Mailing Address - Zip Code:37087-2656
Mailing Address - Country:US
Mailing Address - Phone:615-200-6093
Mailing Address - Fax:615-552-0080
Practice Address - Street 1:1430 W BADDOUR PKWY STE B
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:TN
Practice Address - Zip Code:37087-2656
Practice Address - Country:US
Practice Address - Phone:615-200-6093
Practice Address - Fax:615-552-0080
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LEBANON FAMILY DENTISTRY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-28
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty