Provider Demographics
NPI:1891187753
Name:PREMIER FAMILY DENTISTRY OF PA LLC
Entity Type:Organization
Organization Name:PREMIER FAMILY DENTISTRY OF PA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:BRORING
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:412-882-1700
Mailing Address - Street 1:5208 CLAIRTON BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15236-2711
Mailing Address - Country:US
Mailing Address - Phone:412-882-1700
Mailing Address - Fax:
Practice Address - Street 1:5208 CLAIRTON BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15236-2711
Practice Address - Country:US
Practice Address - Phone:412-882-1700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0381771223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0221XDental ProvidersDentistPediatric DentistryGroup - Multi-Specialty