Premier Dental Seguin

Primary specialty

DentistTaxonomy code 122300000X

License

22462 Issued in TX

Legal business name

PREMIER DENTAL SEGUIN

Practice address

104 W Cedar St
Seguin, TX 78155-3748

Phone

(830) 379-9310

Fax

(830) 401-0230

NPI assigned

Oct 21, 2009

Organization subpart

No

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

Authorized official

Name

Luigi O Massa

Title

Owner

Phone

(830) 625-2111

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1256083200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1256083200000",
    "number": "1881920163",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "104 W CEDAR ST",
            "city": "SEGUIN",
            "state": "TX",
            "postal_code": "781553748",
            "telephone_number": "830-379-9310",
            "fax_number": "830-401-0230"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "104 W CEDAR ST",
            "city": "SEGUIN",
            "state": "TX",
            "postal_code": "781553748",
            "telephone_number": "830-379-9310",
            "fax_number": "830-401-0230"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PREMIER DENTAL SEGUIN",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-10-21",
        "last_updated": "2009-10-21",
        "status": "A",
        "authorized_official_last_name": "MASSA",
        "authorized_official_first_name": "LUIGI",
        "authorized_official_middle_name": "O",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "830-625-2111"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist",
            "state": "TX",
            "license": "22462",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Dentist in Seguin, TX
• Providers in Seguin, TX by specialty
• Dentist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 21, 2009; 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.