1427119338 NPI number — CENTER FOR PREMIER DENTISTRY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427119338 NPI number — CENTER FOR PREMIER DENTISTRY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR PREMIER DENTISTRY
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:
1427119338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3951 SWIFT RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARASOT
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
34231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
941-924-7571
Provider Business Mailing Address Fax Number:
941-922-6815

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3951 SWIFT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SARASOT
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
34231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-924-7571
Provider Business Practice Location Address Fax Number:
941-922-6815
Provider Enumeration Date:
12/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SWARTZ
Authorized Official First Name:
JASON
Authorized Official Middle Name:
J
Authorized Official Title or Position:
DENTIST OWNER
Authorized Official Telephone Number:
941-924-7571

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  15877 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 16315 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 67307 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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