Provider Demographics
NPI:1831292440
Name:PREMIER DENTAL PA
Entity type:Organization
Organization Name:PREMIER DENTAL PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AKBAR
Authorized Official - Middle Name:AGHA
Authorized Official - Last Name:EHRAHIMIAN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:281-277-8787
Mailing Address - Street 1:5814 NEW TERRITORY BLVD
Mailing Address - Street 2:
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77479-5948
Mailing Address - Country:US
Mailing Address - Phone:281-277-8787
Mailing Address - Fax:281-277-8788
Practice Address - Street 1:5814 NEW TERRITORY BLVD
Practice Address - Street 2:
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77479-5948
Practice Address - Country:US
Practice Address - Phone:281-277-8787
Practice Address - Fax:281-277-8788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty