MEDICARE: DREAM DENTAL PARTNERS

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	1223D0001X	Public Health Dentistry

General Provider Information

NPI Number	:	1871291393
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DREAM DENTAL PARTNERS

Provider Business Mailing Address
First Line	:	901 ROSEMARY DR
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75028-5102
Country	:	US
Telephone Number	:	626-755-3751
Fax Number	:

Provider Business Practice Location Address
First Line	:	4041 W WHEATLAND RD STE 202
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75237-4061
Country	:	US
Telephone Number	:	626-755-3751
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	HYUNSIK SAMUEL SUNG
Credential	:	DMD
Telephone Number	:	626-755-3751

Provider Enumeration Date	:	02/23/2023
Last Update Date	:	02/23/2023

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