MEDICARE: PREMIER CARE DENTISTRY LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist

General Provider Information

NPI Number	:	1558957746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER CARE DENTISTRY LLC

Provider Business Mailing Address
First Line	:	135 PINELAWN RD STE 150S
Second Line	:
City	:	MELVILLE
State	:	NY
Zip	:	11747-3187
Country	:	US
Telephone Number	:	631-414-7927
Fax Number	:	631-396-0452

Provider Business Practice Location Address
First Line	:	161 WASHINGTON VALLEY RD STE 208
Second Line	:
City	:	WARREN
State	:	NJ
Zip	:	07059-7177
Country	:	US
Telephone Number	:	732-805-0600
Fax Number	:	631-396-0452

Authorized Official
Title or Position	:	CIO
Name	:	HIRO SORIANO
Credential	:
Telephone Number	:	631-414-7927

Provider Enumeration Date	:	12/12/2020
Last Update Date	:	12/12/2020

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