Provider Demographics
NPI:1639475833
Name:PREMIERE DENTAL CARE PL
Entity Type:Organization
Organization Name:PREMIERE DENTAL CARE PL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIN
Authorized Official - Middle Name:WAI
Authorized Official - Last Name:HUI
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-820-8898
Mailing Address - Street 1:600 S DIXIE HIGHWAY
Mailing Address - Street 2:SUITE 105
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33401
Mailing Address - Country:US
Mailing Address - Phone:561-820-8898
Mailing Address - Fax:561-366-1788
Practice Address - Street 1:600 SOUTH DIXIE HIGHWAY
Practice Address - Street 2:#105
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33401
Practice Address - Country:US
Practice Address - Phone:561-820-8898
Practice Address - Fax:561-366-1788
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIERE DENTAL CARE PL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-02-04
Last Update Date:2011-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN12723122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL071203500Medicaid