Provider Demographics
NPI:1346592565
Name:PREMIER TOXICOLOGY, PLLC
Entity Type:Organization
Organization Name:PREMIER TOXICOLOGY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:H
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:214-985-2624
Mailing Address - Street 1:1000 JOHNSON ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76205-1210
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1000 JOHNSON ST
Practice Address - Street 2:SUITE 1
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76205-1210
Practice Address - Country:US
Practice Address - Phone:214-985-2624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory