Provider Demographics
NPI:1942450218
Name:PREMIER DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:PREMIER DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:617-894-4220
Mailing Address - Street 1:232 POND ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-4366
Mailing Address - Country:US
Mailing Address - Phone:617-894-4220
Mailing Address - Fax:
Practice Address - Street 1:232 POND ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-4366
Practice Address - Country:US
Practice Address - Phone:617-894-4220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-24
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA215411223E0200X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
No1223E0200XDental ProvidersDentistEndodonticsGroup - Multi-Specialty