NPIMap

Organization Active NPI

Premier Dental

  • Dentist
  • London, KY
National Provider Identifier
1104103548
Registry record updated Nov 14, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
7672 Issued in KY
Legal business name
PREMIER DENTAL
Practice address
39 Waco Dr
London, KY 40741-8327
Phone
(606) 877-3002
Fax
(606) 877-3024
NPI assigned
Nov 14, 2011
Last updated
Nov 14, 2011By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Nov 14, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Terri Brown, DMDNPI 1154577013
Title
Dentist
Phone
(606) 877-3002

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 7672 KY Primary

Addresses

Primary practice location

39 Waco Dr
London, KY 40741-8327

Mailing address

39 Waco Dr
London, KY 40741-8327
Phone (606) 877-3002

Other identifiers 1

IdentifierTypeStateIssuer
71000889MedicaidKY

National Provider Directory

National Provider Directory

Locations

39 Waco Dr
London, KY 40741
Phone (606) 877-3002

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1321228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1321228800000",
    "number": "1104103548",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 WACO DR",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407418327",
            "telephone_number": "606-877-3002",
            "fax_number": "606-877-3024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "39 WACO DR",
            "city": "LONDON",
            "state": "KY",
            "postal_code": "407418327",
            "telephone_number": "606-877-3002",
            "fax_number": "606-877-3024"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DENTAL",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-11-14",
        "last_updated": "2011-11-14",
        "status": "A",
        "authorized_official_last_name": "BROWN",
        "authorized_official_first_name": "TERRI",
        "authorized_official_title_or_position": "DENTIST",
        "authorized_official_telephone_number": "606-877-3002",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "KY",
            "license": "7672",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "71000889",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in London, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.