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General NPI Number Information
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NPI Number | 1336512748
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Entity Type | Organization
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Legal Business Name | PREMIER PERIODONTICS
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Dates
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Enumeration Date | 11/06/2015
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Last Update Date | 11/06/2015
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Provider Practice Location Address
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Address Line | 1005 SARA SWAMY DR
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City | SHERMAN
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State | TX
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Zip | 75090-3119
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Country | US
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Telephone | 903-868-9850
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Fax | 903-868-9851
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Provider Business Mailing Address
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Address Line | PO BOX 848
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City | SHERMAN
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State | TX
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Zip | 75091-0848
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Country | US
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Telephone | 903-868-9850
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Fax | 903-868-9851
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. SAMUEL JOSEPH NECHAMKIN
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Credential | DDS, MS
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Telephone | 903-868-9850
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number | 17938
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License Number State | TX
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