Provider Demographics
NPI:1285104455
Name:PREMIER DENTAL CENTER, P.A
Entity type:Organization
Organization Name:PREMIER DENTAL CENTER, P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMBER
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-987-6977
Mailing Address - Street 1:7160 PEMBROKE RD
Mailing Address - Street 2:
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33023-2627
Mailing Address - Country:US
Mailing Address - Phone:954-987-6977
Mailing Address - Fax:954-987-1638
Practice Address - Street 1:7160 PEMBROKE RD
Practice Address - Street 2:
Practice Address - City:MIRAMAR
Practice Address - State:FL
Practice Address - Zip Code:33023-2627
Practice Address - Country:US
Practice Address - Phone:954-987-6977
Practice Address - Fax:954-987-1638
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-30
Last Update Date:2018-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty