Healthcare Provider Details

I. General information

NPI: 1760958854
Provider Name (Legal Business Name): DREAMWORKS DENTAL OF PROSPER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4740 W UNIVERSITY DR STE 180
PROSPER TX
75078-2029
US

IV. Provider business mailing address

4420 N TARRANT PKWY # 146
FORT WORTH TX
76244-4922
US

V. Phone/Fax

Practice location:
  • Phone: 682-593-7800
  • Fax:
Mailing address:
  • Phone: 682-593-7800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number State

VIII. Authorized Official

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