Provider Demographics
NPI:1679817951
Name:DREAM SMILE LLC
Entity Type:Organization
Organization Name:DREAM SMILE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUSMITA
Authorized Official - Middle Name:
Authorized Official - Last Name:PARAB
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-491-5298
Mailing Address - Street 1:6 PHILLIPS CIR
Mailing Address - Street 2:
Mailing Address - City:ASTON
Mailing Address - State:PA
Mailing Address - Zip Code:19014-3613
Mailing Address - Country:US
Mailing Address - Phone:407-491-5298
Mailing Address - Fax:610-571-3393
Practice Address - Street 1:801 UPLAND AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19013-4900
Practice Address - Country:US
Practice Address - Phone:610-499-9999
Practice Address - Fax:610-571-3393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-26
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0366621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty