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General NPI Number Information
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NPI Number | 1851295091
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Entity Type | Organization
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Legal Business Name | PREMIER MOBILE DENTISTRY LLC
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Dates
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Enumeration Date | 10/02/2026
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Last Update Date | 10/02/2026
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Provider Practice Location Address
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Address Line | 1957 S HAMPTON AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65807-2727
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Country | US
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Telephone | 201-970-8441
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Fax |
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Provider Business Mailing Address
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Address Line | 1957 S HAMPTON AVE
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City | SPRINGFIELD
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State | MO
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Zip | 65807-2727
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Country | US
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Telephone | 201-970-8441
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ZAKI MINAS
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Credential |
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Telephone | 201-970-8441
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State | NULL
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