Provider Demographics
NPI:1497862825
Name:PREMIER DENTAL GROUP PC
Entity Type:Organization
Organization Name:PREMIER DENTAL GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:D
Authorized Official - Last Name:COPPES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-736-2273
Mailing Address - Street 1:7891 BROADWAY
Mailing Address - Street 2:STE C
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410
Mailing Address - Country:US
Mailing Address - Phone:219-736-2273
Mailing Address - Fax:
Practice Address - Street 1:7891 BROADWAY
Practice Address - Street 2:STE C
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410
Practice Address - Country:US
Practice Address - Phone:219-736-2273
Practice Address - Fax:219-769-5233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty