Provider Demographics
NPI:1497928063
Name:PREMIER DENTAL INC
Entity Type:Organization
Organization Name:PREMIER DENTAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIELLE
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:GREENE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:404-915-1666
Mailing Address - Street 1:8097 ROSWELL RD
Mailing Address - Street 2:BLDG E
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30350-6159
Mailing Address - Country:US
Mailing Address - Phone:770-642-4711
Mailing Address - Fax:
Practice Address - Street 1:8097 ROSWELL RD
Practice Address - Street 2:BLDG E
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30350-6159
Practice Address - Country:US
Practice Address - Phone:770-642-4711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-03
Last Update Date:2008-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0119731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00814965CMedicaid