Provider Demographics
NPI:1083995526
Name:DENTAL DREAMS, PLLC
Entity Type:Organization
Organization Name:DENTAL DREAMS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ENROLLMENT/DEVELOPMENT COORD.
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-274-4526
Mailing Address - Street 1:2501 W PIERSON RD
Mailing Address - Street 2:UNITS B-D
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-6802
Mailing Address - Country:US
Mailing Address - Phone:810-789-5880
Mailing Address - Fax:
Practice Address - Street 1:2501 W PIERSON RD
Practice Address - Street 2:UNITS B-D
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-6802
Practice Address - Country:US
Practice Address - Phone:810-789-5880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-29
Last Update Date:2011-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010205151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty