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NPI Code Detail

MEDICARE: DENTAL DREAMS, PLLC

MEDICARE: DENTAL DREAMS, PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11223G0001XGeneral Practice Dentistry2901020515MI

General Provider Information

NPI Number : 1083995526
Entity Type Code : Organization
Provider Name (Legal Business Name) : DENTAL DREAMS, PLLC
Provider Business Mailing Address
First Line : 2501 W PIERSON RD
Second Line : UNITS B-D
City : FLINT
State : MI
Zip : 48504-6802
Country : US
Telephone Number : 810-789-5880
Fax Number :
Provider Business Practice Location Address
First Line : 2501 W PIERSON RD
Second Line : UNITS B-D
City : FLINT
State : MI
Zip : 48504-6802
Country : US
Telephone Number : 810-789-5880
Fax Number :
Authorized Official
Title or Position : ENROLLMENT/DEVELOPMENT COORD.
Name : ELIZABETH LEE
Credential :
Telephone Number : 312-274-4526
Provider Enumeration Date : 08/29/2011
Last Update Date : 08/29/2011

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