Provider Demographics
NPI:1902160450
Name:PREMIER DENTAL CENTER
Entity Type:Organization
Organization Name:PREMIER DENTAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:LEONARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:731-300-3000
Mailing Address - Street 1:2574 CHRISTMASVILLE CV
Mailing Address - Street 2:SUITE G
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38305-7011
Mailing Address - Country:US
Mailing Address - Phone:731-300-3000
Mailing Address - Fax:731-300-3031
Practice Address - Street 1:2574 CHRISTMASVILLE CV
Practice Address - Street 2:SUITE G
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38305-7011
Practice Address - Country:US
Practice Address - Phone:731-300-3000
Practice Address - Fax:731-300-3031
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-29
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS34131223G0001X
TNDS77901223G0001X
TNDS84011223G0001X
TNDS36821223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty