Provider Demographics
NPI:1346016029
Name:PREMIER DENTAL CARE OF BUCKHEAD, LLC
Entity type:Organization
Organization Name:PREMIER DENTAL CARE OF BUCKHEAD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:TRENT
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:COLLETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:404-266-0111
Mailing Address - Street 1:3580 PIEDMONT RD NE STE 113
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30305-1506
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3580 PIEDMONT RD NE STE 113
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30305-1506
Practice Address - Country:US
Practice Address - Phone:404-266-0111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-04
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty