MEDICARE: DENTAL DREAMS, LLC

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	010099	CT

General Provider Information

NPI Number	:	1588998884
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL DREAMS, LLC

Provider Business Mailing Address
First Line	:	4575 MAIN ST UNIT 125
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-1818
Country	:	US
Telephone Number	:	312-274-0308
Fax Number	:

Provider Business Practice Location Address
First Line	:	4575 MAIN ST UNIT 125
Second Line	:
City	:	BRIDGEPORT
State	:	CT
Zip	:	06606-1818
Country	:	US
Telephone Number	:	312-274-0308
Fax Number	:

Authorized Official
Title or Position	:	OWNER / DENTIST
Name	:	SAMEERA HUSSAIN
Credential	:	D.M.D.
Telephone Number	:	630-750-1405

Provider Enumeration Date	:	09/21/2009
Last Update Date	:	09/21/2009

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