Healthcare Provider Details

I. General information

NPI: 1508102120
Provider Name (Legal Business Name): PREMIER PERIODONTICS PPLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2012
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10050 NE 10TH ST SUITE C
BELLEVUE WA
98004
US

IV. Provider business mailing address

10050 NE 10TH ST SUITE C
BELLEVUE WA
98004
US

V. Phone/Fax

Practice location:
  • Phone: 425-455-2020
  • Fax: 425-455-0310
Mailing address:
  • Phone: 425-455-2020
  • Fax: 425-455-0310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number
License Number State

VIII. Authorized Official

Name: DR. WILL S FERNYHOUGH
Title or Position: DOCTOR
Credential: DDS,MSD
Phone: 425-455-2020