Provider Demographics
NPI:1598003865
Name:PREMIERE DENTAL LLC
Entity Type:Organization
Organization Name:PREMIERE DENTAL LLC
Other - Org Name:PREMIERE DENTAL SPA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TENESHIA
Authorized Official - Middle Name:E
Authorized Official - Last Name:DANIELS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:256-469-6428
Mailing Address - Street 1:5045 MEMORIAL PKWY NW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35810-1077
Mailing Address - Country:US
Mailing Address - Phone:601-880-6424
Mailing Address - Fax:
Practice Address - Street 1:5045 MEMORIAL PKWY NW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35810-1077
Practice Address - Country:US
Practice Address - Phone:601-880-6424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-22
Last Update Date:2021-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALAL5820122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty