1821269507 NPI number — PREMIER DENTAL GROUP, PLLC OF KNOXVILLE

Table of content: (NPI 1821269507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821269507 NPI number — PREMIER DENTAL GROUP, PLLC OF KNOXVILLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER DENTAL GROUP, PLLC OF KNOXVILLE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ORTHODONTIC DESIGNS BY MICHAEL SAWAF DMD, PLLC
Provider Other Organization Name Type Code:
4
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821269507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/14/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PREMIER DENTAL GROUP, PLLC OF KNOXVILLE
Provider Second Line Business Mailing Address:
303 S CONCORD ST STE. 323 STE
Provider Business Mailing Address City Name:
KNOXVILLE
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37919
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
865-637-5708
Provider Business Mailing Address Fax Number:
865-637-5712

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PREMIER DENTAL GROUP, PLLC OF KNOXVILLE
Provider Second Line Business Practice Location Address:
303 S CONCORD ST STE. 323 STE
Provider Business Practice Location Address City Name:
KNOXVILLE
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
865-637-5708
Provider Business Practice Location Address Fax Number:
865-637-5712
Provider Enumeration Date:
03/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SAWAF
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
ORTHODONTIST
Authorized Official Telephone Number:
865-637-5708

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  8480 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com