Provider Demographics
NPI:1639422108
Name:PREFERRED PLASTIC SURGERY & SKIN CARE CENTER LLC
Entity Type:Organization
Organization Name:PREFERRED PLASTIC SURGERY & SKIN CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PERRINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-554-7573
Mailing Address - Street 1:5250 FAR HILLS AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45429-2382
Mailing Address - Country:US
Mailing Address - Phone:937-432-9810
Mailing Address - Fax:937-432-9815
Practice Address - Street 1:5250 FAR HILLS AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45429-2382
Practice Address - Country:US
Practice Address - Phone:937-432-9810
Practice Address - Fax:937-432-9815
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-22
Last Update Date:2013-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
E36626Medicare UPIN