Premier Dental of Edgmont Square LLC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

PREMIER DENTAL OF EDGMONT SQUARE LLC

Practice address

4753 W Chester Pike
Newtown Square, PA 19073-2212

Phone

(484) 424-0078

NPI assigned

Mar 21, 2017

Organization subpart

No

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

Authorized official

Name

Mike Cole

Title

VP Insurance Plan Management

Phone

(941) 955-3150

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1490054400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1492992000000",
    "number": "1801327002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4753 W CHESTER PIKE",
            "city": "NEWTOWN SQUARE",
            "state": "PA",
            "postal_code": "190732212",
            "telephone_number": "484-424-0078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4753 W CHESTER PIKE",
            "city": "NEWTOWN SQUARE",
            "state": "PA",
            "postal_code": "190732212",
            "telephone_number": "484-424-0078"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DENTAL OF EDGMONT SQUARE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-03-21",
        "last_updated": "2017-04-24",
        "status": "A",
        "authorized_official_last_name": "COLE",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "VP INSURANCE PLAN MANAGEMENT",
        "authorized_official_telephone_number": "941-955-3150"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• All providers in Newtown Square, PA
• Dentist in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 2017; 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.