Provider Demographics
NPI:1740975507
Name:DREAM SMILE DENTAL INC
Entity type:Organization
Organization Name:DREAM SMILE DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAILA
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANUMULA
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:630-793-9480
Mailing Address - Street 1:1N141 COUNTY FARM RD STE 150
Mailing Address - Street 2:
Mailing Address - City:WINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60190-2087
Mailing Address - Country:US
Mailing Address - Phone:630-793-9480
Mailing Address - Fax:630-793-9417
Practice Address - Street 1:1N141 COUNTY FARM RD STE 150
Practice Address - Street 2:
Practice Address - City:WINFIELD
Practice Address - State:IL
Practice Address - Zip Code:60190-2087
Practice Address - Country:US
Practice Address - Phone:630-793-9480
Practice Address - Fax:630-793-9417
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-04-07
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental