Provider Demographics
NPI:1467708297
Name:DREAM-DENTISTRY LLC
Entity Type:Organization
Organization Name:DREAM-DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:GORDON
Authorized Official - Middle Name:SEBASTIAN
Authorized Official - Last Name:ROEDER
Authorized Official - Suffix:JR
Authorized Official - Credentials:DMD
Authorized Official - Phone:215-538-1109
Mailing Address - Street 1:1326 W BROAD ST
Mailing Address - Street 2:
Mailing Address - City:QUAKERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18951-1108
Mailing Address - Country:US
Mailing Address - Phone:215-538-1109
Mailing Address - Fax:215-536-6114
Practice Address - Street 1:1326 W BROAD ST
Practice Address - Street 2:
Practice Address - City:QUAKERTOWN
Practice Address - State:PA
Practice Address - Zip Code:18951-1108
Practice Address - Country:US
Practice Address - Phone:215-538-1109
Practice Address - Fax:215-536-6114
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-30
Last Update Date:2012-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025683L332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment