Healthcare Provider Details

I. General information

NPI: 1083854038
Provider Name (Legal Business Name): DREAMWORKS DENTAL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2009
Last Update Date: 12/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 ESTERS RD SUITE #100
IRVING TX
75061-9531
US

IV. Provider business mailing address

2000 ESTERS RD SUITE #100
IRVING TX
75061-9531
US

V. Phone/Fax

Practice location:
  • Phone: 972-906-5550
  • Fax:
Mailing address:
  • Phone: 972-871-9800
  • Fax: 972-871-9802

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number23999
License Number StateTX

VIII. Authorized Official

Name: DR. MARIA L NGUYEN
Title or Position: PRESIDENT
Credential: DMD
Phone: 954-608-9984