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General NPI Number Information
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NPI Number | 1699120808
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Entity Type | Organization
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Legal Business Name | PREMIER BOERNE DENTAL, PLLC
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Dates
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Enumeration Date | 04/26/2016
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Last Update Date | 04/26/2016
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Provider Practice Location Address
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Address Line | 804 N MAIN ST
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City | BOERNE
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State | TX
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Zip | 78006-1626
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Country | US
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Telephone | 830-249-8407
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Fax |
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Provider Business Mailing Address
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Address Line | 804 N MAIN ST
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City | BOERNE
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State | TX
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Zip | 78006-1626
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Country | US
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Telephone | 830-249-8407
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. LUIGI MASSA
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Credential | D.D.S.
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Telephone | 830-660-1669
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 22462
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License Number State | TX
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