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General NPI Number Information
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NPI Number | 1851411367
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Entity Type | Organization
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Legal Business Name | PREMIERE MAXILLOFACIAL SURGEONS, INC.
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Dates
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Enumeration Date | 03/29/2007
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Last Update Date | 11/17/2015
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Provider Practice Location Address
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Address Line | 3132 HARRISON AVE
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City | EUREKA
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State | CA
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Zip | 95503-5638
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Country | US
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Telephone | 707-442-1775
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Fax | 707-444-2821
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Provider Business Mailing Address
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Address Line | 3132 HARRISON AVE
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City | EUREKA
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State | CA
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Zip | 95503-5638
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Country | US
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Telephone | 707-442-1775
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Fax | 707-444-2821
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WILLIAM H TETTEH-MARTEY
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Credential | DMD
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Telephone | 626-665-9279
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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 | 52119
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License Number State | CA
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