Provider Demographics
NPI:1003410788
Name:DREAM DENTAL ANESTHESIA SOLUTIONS, PLLC
Entity Type:Organization
Organization Name:DREAM DENTAL ANESTHESIA SOLUTIONS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNA/CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:NYDAM
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:720-830-5544
Mailing Address - Street 1:10233 S PARKER RD STE 300
Mailing Address - Street 2:
Mailing Address - City:PARKER
Mailing Address - State:CO
Mailing Address - Zip Code:80134-9365
Mailing Address - Country:US
Mailing Address - Phone:720-830-5544
Mailing Address - Fax:
Practice Address - Street 1:10233 S PARKER RD STE 300
Practice Address - Street 2:
Practice Address - City:PARKER
Practice Address - State:CO
Practice Address - Zip Code:80134-9365
Practice Address - Country:US
Practice Address - Phone:720-830-5544
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-24
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty