Healthcare Provider Details

I. General information

NPI: 1497928063
Provider Name (Legal Business Name): PREMIER DENTAL INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2008
Last Update Date: 04/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8097 ROSWELL RD BLDG E
ATLANTA GA
30350-6159
US

IV. Provider business mailing address

8097 ROSWELL RD BLDG E
ATLANTA GA
30350-6159
US

V. Phone/Fax

Practice location:
  • Phone: 770-642-4711
  • Fax:
Mailing address:
  • Phone: 770-642-4711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number011973
License Number StateGA

VIII. Authorized Official

Name: DR. DANIELLE DENISE GREENE
Title or Position: PRESIDENT
Credential: DDS
Phone: 404-915-1666