Provider Demographics
NPI:1710221783
Name:PREMIER DENTAL HEALTH L.L.C.
Entity Type:Organization
Organization Name:PREMIER DENTAL HEALTH L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RDH
Authorized Official - Phone:970-379-8030
Mailing Address - Street 1:PO BOX 1961
Mailing Address - Street 2:
Mailing Address - City:GLENWOOD SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:81602-1961
Mailing Address - Country:US
Mailing Address - Phone:970-379-8030
Mailing Address - Fax:
Practice Address - Street 1:214 8TH ST
Practice Address - Street 2:SUITE 305
Practice Address - City:GLENWOOD SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:81601-3326
Practice Address - Country:US
Practice Address - Phone:970-379-8030
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2012-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2806124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty