Provider Demographics
NPI:1033594411
Name:PREMIER ORAL SURGERY AND IMPLANTS, PLC
Entity Type:Organization
Organization Name:PREMIER ORAL SURGERY AND IMPLANTS, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRESHA
Authorized Official - Middle Name:KAYE
Authorized Official - Last Name:YORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:810-445-9970
Mailing Address - Street 1:5090 E HILL RD
Mailing Address - Street 2:
Mailing Address - City:GRAND BLANC
Mailing Address - State:MI
Mailing Address - Zip Code:48439-7637
Mailing Address - Country:US
Mailing Address - Phone:810-445-9970
Mailing Address - Fax:810-445-9971
Practice Address - Street 1:5090 E HILL RD
Practice Address - Street 2:
Practice Address - City:GRAND BLANC
Practice Address - State:MI
Practice Address - Zip Code:48439-7637
Practice Address - Country:US
Practice Address - Phone:810-445-9970
Practice Address - Fax:810-445-9971
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-27
Last Update Date:2020-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010171701223S0112X
MI1223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIU89030Medicare UPIN