Healthcare Provider Details

I. General information

NPI: 1104412394
Provider Name (Legal Business Name): PREMIER CARE DENTISTRY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2020
Last Update Date: 12/12/2020
Certification Date: 12/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 SHELLEY DR STE 1E
HACKETTSTOWN NJ
07840-2530
US

IV. Provider business mailing address

135 PINELAWN RD STE 150S
MELVILLE NY
11747-3187
US

V. Phone/Fax

Practice location:
  • Phone: 908-813-9700
  • Fax: 631-396-0452
Mailing address:
  • Phone: 631-414-7927
  • Fax: 631-396-0452

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number
License Number State

VIII. Authorized Official

Name: HIRO SORIANO
Title or Position: CIO
Credential:
Phone: 631-414-7927