Premier Dental & Implant Studio

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DN15549 Issued in FL

Legal business name

PREMIER DENTAL & IMPLANT STUDIO

Practice address

20321 Grande Oak Shoppes Blvd Ste 316
Estero, FL 33928-7697

Phone

(239) 992-0325

Fax

(239) 992-0329

NPI assigned

May 1, 2014

Organization subpart

Yes

Parent organization

COLLIER ORAL SURGERY & IMPLANT CENTERAs reported in NPPES

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

Authorized official

Name

Diana Colmenares

Title

Practice Manager

Phone

(239) 254-9933

Specialties & licenses 2

Addresses

Part of

Premier Dental Implant Studio

Locations

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

{
    "created_epoch": "1398902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1398902400000",
    "number": "1134539935",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20321 GRANDE OAK SHOPPES BLVD STE 316",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "339287697",
            "telephone_number": "239-992-0325",
            "fax_number": "239-992-0329"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "20321 GRANDE OAK SHOPPES BLVD STE 316",
            "city": "ESTERO",
            "state": "FL",
            "postal_code": "339287697",
            "telephone_number": "239-992-0325",
            "fax_number": "239-992-0329"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DENTAL & IMPLANT STUDIO",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "COLLIER ORAL SURGERY & IMPLANT CENTER",
        "enumeration_date": "2014-05-01",
        "last_updated": "2014-05-01",
        "status": "A",
        "authorized_official_last_name": "COLMENARES",
        "authorized_official_first_name": "DIANA",
        "authorized_official_title_or_position": "PRACTICE MANAGER",
        "authorized_official_telephone_number": "239-254-9933"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, General Practice",
            "state": "FL",
            "license": "DN15549",
            "primary": true
        },
        {
            "code": "1223S0112X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist, Oral and Maxillofacial Surgery",
            "state": "FL",
            "license": "DN15449",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2014; 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.