Provider Demographics
NPI:1740038074
Name:PREMIER DENTAL WELLNESS LLC
Entity type:Organization
Organization Name:PREMIER DENTAL WELLNESS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:FRANK
Authorized Official - Last Name:MARZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:912-682-3815
Mailing Address - Street 1:1130 BRAMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATESBORO
Mailing Address - State:GA
Mailing Address - Zip Code:30458-0847
Mailing Address - Country:US
Mailing Address - Phone:912-764-3724
Mailing Address - Fax:912-489-3721
Practice Address - Street 1:1130 BRAMPTON AVE
Practice Address - Street 2:
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458-0847
Practice Address - Country:US
Practice Address - Phone:912-764-3724
Practice Address - Fax:912-489-3721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-05-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty