Provider Demographics
NPI:1609573005
Name:PREMIER DENTAL
Entity Type:Organization
Organization Name:PREMIER DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:MESTIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLOMON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:703-740-0060
Mailing Address - Street 1:611 S CARLIN SPRINGS RD STE 408
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204-1087
Mailing Address - Country:US
Mailing Address - Phone:703-740-0060
Mailing Address - Fax:703-740-0059
Practice Address - Street 1:611 S CARLIN SPRINGS RD STE 408
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1087
Practice Address - Country:US
Practice Address - Phone:703-740-0060
Practice Address - Fax:703-740-0059
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-02-15
Last Update Date:2023-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty