Provider Demographics
NPI:1336512748
Name:PREMIER PERIODONTICS
Entity Type:Organization
Organization Name:PREMIER PERIODONTICS
Other - Org Name:PREMIER DENTISTRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMUEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:NECHAMKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:903-868-9850
Mailing Address - Street 1:PO BOX 848
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:TX
Mailing Address - Zip Code:75091-0848
Mailing Address - Country:US
Mailing Address - Phone:903-868-9850
Mailing Address - Fax:903-868-9851
Practice Address - Street 1:1005 SARA SWAMY DR
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:TX
Practice Address - Zip Code:75090-3119
Practice Address - Country:US
Practice Address - Phone:903-868-9850
Practice Address - Fax:903-868-9851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-06
Last Update Date:2015-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17938261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental