Provider Demographics
NPI:1790216364
Name:DENTAL DREAMS, LLC
Entity Type:Organization
Organization Name:DENTAL DREAMS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:CARPIO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-468-5333
Mailing Address - Street 1:5632 NW 167TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI LAKES
Mailing Address - State:FL
Mailing Address - Zip Code:33014-6135
Mailing Address - Country:US
Mailing Address - Phone:305-625-9777
Mailing Address - Fax:305-625-2009
Practice Address - Street 1:5632 NW 167TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI LAKES
Practice Address - State:FL
Practice Address - Zip Code:33014-6135
Practice Address - Country:US
Practice Address - Phone:305-625-9777
Practice Address - Fax:305-625-2009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-24
Last Update Date:2017-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN162911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty