Provider Demographics
NPI:1619116936
Name:PREMIERE DENTAL CARE, INC.
Entity Type:Organization
Organization Name:PREMIERE DENTAL CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YASUHIRO
Authorized Official - Middle Name:
Authorized Official - Last Name:MATSUMURA
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:310-575-8828
Mailing Address - Street 1:11340 W. OLYMPIC BLVD
Mailing Address - Street 2:#240
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064
Mailing Address - Country:US
Mailing Address - Phone:310-575-8828
Mailing Address - Fax:818-591-5895
Practice Address - Street 1:11340 W. OLYMPIC BLVD
Practice Address - Street 2:#240
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064
Practice Address - Country:US
Practice Address - Phone:310-575-8828
Practice Address - Fax:818-591-5895
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-10
Last Update Date:2009-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39304122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty