Provider Demographics
NPI:1225528656
Name:DREAM SMILE FAMILY DENTISTRY, PLC
Entity Type:Organization
Organization Name:DREAM SMILE FAMILY DENTISTRY, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER/DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:ARCHANA
Authorized Official - Middle Name:
Authorized Official - Last Name:REJINTALA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-566-6549
Mailing Address - Street 1:41646 BOSTONIAN PL
Mailing Address - Street 2:
Mailing Address - City:ALDIE
Mailing Address - State:VA
Mailing Address - Zip Code:20105-5648
Mailing Address - Country:US
Mailing Address - Phone:904-566-6549
Mailing Address - Fax:
Practice Address - Street 1:24805 PINEBROOK RD STE 212
Practice Address - Street 2:
Practice Address - City:SOUTH RIDING
Practice Address - State:VA
Practice Address - Zip Code:20152-4128
Practice Address - Country:US
Practice Address - Phone:904-566-6549
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-10
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental