Healthcare Provider Details

I. General information

NPI: 1588545933
Provider Name (Legal Business Name): PREMIER CARE DENTISTRY OF OHIO LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2025
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5012 TALMADGE RD
TOLEDO OH
43623-2167
US

IV. Provider business mailing address

105 MAXESS RD STE 107N
MELVILLE NY
11747-3859
US

V. Phone/Fax

Practice location:
  • Phone: 419-474-9611
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JONATHAN LIEBLING
Title or Position: COO
Credential:
Phone: 631-414-7927