Provider Demographics
NPI:1205117041
Name:DENTAL DREAMS PLLC
Entity type:Organization
Organization Name:DENTAL DREAMS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:STATHAKIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-274-0308
Mailing Address - Street 1:3890 DIXIE HWY
Mailing Address - Street 2:STE #1A
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48601-4205
Mailing Address - Country:US
Mailing Address - Phone:989-777-4880
Mailing Address - Fax:
Practice Address - Street 1:3890 DIXIE HWY
Practice Address - Street 2:STE #1A
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48601-4205
Practice Address - Country:US
Practice Address - Phone:989-777-4880
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-07
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010205151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty