Provider Demographics
NPI:1821269507
Name:PREMIER DENTAL GROUP, PLLC OF KNOXVILLE
Entity Type:Organization
Organization Name:PREMIER DENTAL GROUP, PLLC OF KNOXVILLE
Other - Org Name:ORTHODONTIC DESIGNS BY MICHAEL SAWAF DMD, PLLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ORTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SAWAF
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:865-637-5708
Mailing Address - Street 1:PREMIER DENTAL GROUP, PLLC OF KNOXVILLE
Mailing Address - Street 2:303 S CONCORD ST STE. 323 STE
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37919
Mailing Address - Country:US
Mailing Address - Phone:865-637-5708
Mailing Address - Fax:865-637-5712
Practice Address - Street 1:PREMIER DENTAL GROUP, PLLC OF KNOXVILLE
Practice Address - Street 2:303 S CONCORD ST STE. 323 STE
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37919
Practice Address - Country:US
Practice Address - Phone:865-637-5708
Practice Address - Fax:865-637-5712
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-20
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN8480261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center