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General NPI Number Information
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NPI Number | 1801210844
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Entity Type | Organization
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Legal Business Name | PREMIER DENTAL,PLLC
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Dates
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Enumeration Date | 02/11/2014
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Last Update Date | 03/29/2016
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Provider Practice Location Address
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Address Line | 1438 E. AUGUSTINE LANE SUITE 1
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4943
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Country | US
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Telephone | 479-251-9000
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Fax | 479-251-9002
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Provider Business Mailing Address
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Address Line | 1438 E. AUGUSTINE LANE SUITE 1
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City | FAYETTEVILLE
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State | AR
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Zip | 72703-4943
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Country | US
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Telephone | 479-251-9000
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Fax | 479-251-9002
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | LEANN SARGENT
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Credential |
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Telephone | 479-251-9000
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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 | 3473
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License Number State | AR
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