Provider Demographics
NPI:1386001006
Name:PREMIER DENTAL CARE
Entity Type:Organization
Organization Name:PREMIER DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOBOL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:410-374-4882
Mailing Address - Street 1:2730 HANOVER PIKE
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:MD
Mailing Address - Zip Code:21102-1914
Mailing Address - Country:US
Mailing Address - Phone:410-374-4882
Mailing Address - Fax:410-374-0702
Practice Address - Street 1:2730 HANOVER PIKE
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:MD
Practice Address - Zip Code:21102-1914
Practice Address - Country:US
Practice Address - Phone:410-374-4882
Practice Address - Fax:410-374-0702
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-26
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD131891223G0001X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty