Premier Denture Center LLC

Primary specialty

DentistTaxonomy code 122300000X

License

30023358 Issued in OH

Legal business name

PREMIER DENTURE CENTER LLC

Practice address

184 E South Boundary St Ste 7
Perrysburg, OH 43551-2527

Phone

(419) 874-5324

Fax

(419) 874-5324

NPI assigned

Mar 10, 2011

Organization subpart

No

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

Authorized official

Name

Michael Allen Moore, DMD

Title

Ceo Dental Operations

Phone

(419) 874-5324

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1299715200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1299715200000",
    "number": "1699073924",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "184 E SOUTH BOUNDARY ST STE 7",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435512527",
            "telephone_number": "419-874-5324",
            "fax_number": "419-874-5324"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "184 E SOUTH BOUNDARY ST STE 7",
            "city": "PERRYSBURG",
            "state": "OH",
            "postal_code": "435512527",
            "telephone_number": "419-874-5324",
            "fax_number": "419-874-5324"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DENTURE CENTER LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-10",
        "last_updated": "2011-03-10",
        "status": "A",
        "authorized_official_last_name": "MOORE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "ALLEN",
        "authorized_official_title_or_position": "CEO DENTAL OPERATIONS",
        "authorized_official_telephone_number": "419-874-5324",
        "authorized_official_credential": "DMD"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "OH",
            "license": "30023358",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Perrysburg, OH
• Providers in Perrysburg, OH by specialty
• Dentist in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 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.