Provider Demographics
NPI:1184094880
Name:PREMIER DENTAL & ORAL HEALTH GROUP,P.C.
Entity type:Organization
Organization Name:PREMIER DENTAL & ORAL HEALTH GROUP,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:MASSIE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:573-365-0220
Mailing Address - Street 1:24 N SHORE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE OZARK
Mailing Address - State:MO
Mailing Address - Zip Code:65049-7111
Mailing Address - Country:US
Mailing Address - Phone:573-365-0220
Mailing Address - Fax:573-365-1962
Practice Address - Street 1:24 N SHORE DR
Practice Address - Street 2:
Practice Address - City:LAKE OZARK
Practice Address - State:MO
Practice Address - Zip Code:65049-7111
Practice Address - Country:US
Practice Address - Phone:573-365-0220
Practice Address - Fax:573-365-1962
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PREMIER DENTAL & ORAL HEALTH GROUP,P.C.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO15226332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment