Provider Demographics
NPI:1043308000
Name:VICTOR E PREMEN DDS PC
Entity Type:Organization
Organization Name:VICTOR E PREMEN DDS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VICTOR
Authorized Official - Middle Name:E
Authorized Official - Last Name:PREMEN
Authorized Official - Suffix:SR
Authorized Official - Credentials:DDS
Authorized Official - Phone:734-782-3087
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:
Mailing Address - City:FLAT ROCK
Mailing Address - State:MI
Mailing Address - Zip Code:48134-2028
Mailing Address - Country:US
Mailing Address - Phone:734-782-3087
Mailing Address - Fax:734-782-9733
Practice Address - Street 1:26332 E HURON RIVER DR
Practice Address - Street 2:
Practice Address - City:FLAT ROCK
Practice Address - State:MI
Practice Address - Zip Code:48134-1553
Practice Address - Country:US
Practice Address - Phone:734-782-3087
Practice Address - Fax:734-782-9733
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901009955261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental