MEDICARE: DREAMWORKS DENTAL OF NORTH TARRANT, 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
1	1223G0001X	General Practice Dentistry		TX

General Provider Information

NPI Number	:	1538609219
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAMWORKS DENTAL OF NORTH TARRANT, PLLC

Provider Business Mailing Address
First Line	:	2000 ESTERS RD
Second Line	:	SUITE#100
City	:	IRVING
State	:	TX
Zip	:	75061-9531
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4420 N TARRANT PKWY
Second Line	:	SUITE #146
City	:	FORT WORTH
State	:	TX
Zip	:	76244-4922
Country	:	US
Telephone Number	:	682-593-7800
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MARIA NGUYEN
Credential	:	DMD
Telephone Number	:	682-593-7800

Provider Enumeration Date	:	03/01/2017
Last Update Date	:	03/01/2017

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