1033514849 NPI number — PREMIER DENTAL & IMPLANT CENTER

Table of content: JENNIFER MARIE MURPHY RN, ACNP (NPI 1932657087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033514849 NPI number — PREMIER DENTAL & IMPLANT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER DENTAL & IMPLANT CENTER
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:
Provider Other Organization Name Type Code:
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:
1033514849
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9641 W 153RD ST STE 41
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORLAND PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60462-4603
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
708-873-9709
Provider Business Mailing Address Fax Number:
708-873-1388

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9641 W 153RD ST STE 41
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORLAND PARK
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60462-4603
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
708-873-9709
Provider Business Practice Location Address Fax Number:
708-873-1388
Provider Enumeration Date:
10/23/2014

Additional Information

Authorized Official

Authorized Official Last Name:
AKHRAS
Authorized Official First Name:
YAMEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
708-873-9709

Provider Taxonomy Codes

  • Taxonomy code: 1223G0001X , registered in the state of ID ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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