Provider Demographics
NPI:1699402230
Name:PREMIER CARE DENTISTRY LLC
Entity type:Organization
Organization Name:PREMIER CARE DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CIO
Authorized Official - Prefix:
Authorized Official - First Name:HIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:SORIANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-147-9276
Mailing Address - Street 1:105 MAXESS RD STE 107N
Mailing Address - Street 2:
Mailing Address - City:MELVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11747-3859
Mailing Address - Country:US
Mailing Address - Phone:631-414-7927
Mailing Address - Fax:631-396-0452
Practice Address - Street 1:1640 US HIGHWAY 22 E
Practice Address - Street 2:
Practice Address - City:WATCHUNG
Practice Address - State:NJ
Practice Address - Zip Code:07069-6503
Practice Address - Country:US
Practice Address - Phone:908-388-1088
Practice Address - Fax:631-396-0452
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-03
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty