Provider Demographics
NPI:1750933545
Name:PREMIER ORAL & FACIAL SURGERY
Entity type:Organization
Organization Name:PREMIER ORAL & FACIAL SURGERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDONIS
Authorized Official - Middle Name:
Authorized Official - Last Name:TEREZIDES
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:407-621-1900
Mailing Address - Street 1:13571 NARCOOSSEE ROAD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32832
Mailing Address - Country:US
Mailing Address - Phone:407-553-2894
Mailing Address - Fax:
Practice Address - Street 1:13571 NARCOOSSEE ROAD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32832-6952
Practice Address - Country:US
Practice Address - Phone:407-553-2894
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-11
Last Update Date:2021-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial SurgeryGroup - Multi-Specialty