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General NPI Number Information
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NPI Number | 1205117041
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Entity Type | Organization
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Legal Business Name | DENTAL DREAMS PLLC
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Dates
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Enumeration Date | 09/07/2011
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Last Update Date | 09/17/2015
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Provider Practice Location Address
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Address Line | 3890 DIXIE HWY STE #1A
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City | SAGINAW
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State | MI
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Zip | 48601-4205
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Country | US
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Telephone | 989-777-4880
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Fax |
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Provider Business Mailing Address
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Address Line | 3890 DIXIE HWY STE #1A
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City | SAGINAW
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State | MI
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Zip | 48601-4205
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Country | US
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Telephone | 989-777-4880
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | PETER STATHAKIS
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Credential |
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Telephone | 312-274-0308
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 2901020515
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License Number State | MI
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