Provider Demographics
NPI:1558801951
Name:PREMIER FAMILY DENTISTRY
Entity Type:Organization
Organization Name:PREMIER FAMILY DENTISTRY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:TAE-YON
Authorized Official - Last Name:BYON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:714-539-5013
Mailing Address - Street 1:9710 GARDEN GROVE BLVD
Mailing Address - Street 2:#B
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92844-1644
Mailing Address - Country:US
Mailing Address - Phone:714-539-5013
Mailing Address - Fax:714-539-6013
Practice Address - Street 1:9710 GARDEN GROVE BLVD
Practice Address - Street 2:#B
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-1644
Practice Address - Country:US
Practice Address - Phone:714-539-5013
Practice Address - Fax:714-539-6013
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER FAMILY DENTISTRY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-03-03
Last Update Date:2017-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty