Provider Demographics
NPI:1629580741
Name:SWEET DREAMS DENTAL ANESTHESIA, PLLC
Entity Type:Organization
Organization Name:SWEET DREAMS DENTAL ANESTHESIA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROZDOLSKI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:917-903-1630
Mailing Address - Street 1:217 E 96TH ST APT 26L
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-4122
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:37 NORTH AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-3827
Practice Address - Country:US
Practice Address - Phone:917-903-1630
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY056669122300000X
CT11448122300000X
MADN1857802122300000X
NY0011621223D0004X
CT84941223D0004X
MADN2228213-A1223D0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0004XDental ProvidersDentistDentist AnesthesiologistGroup - Single Specialty
No122300000XDental ProvidersDentistGroup - Single Specialty