| Organization Name: | PREMIER DENTAL & ORAL HEALTH GROUP,P.C. |
| NPI Number: | 1184094880 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | RONALD E MASSIE (PRESIDENT/ OWNER) |
| Mailing Address: | 24 N Shore Dr Lake Ozark |
| State: | MO US |
| Postal Code: | 650497111 |
| Phone Number: | 5733650220 |
| Fax Number: | 5733651962 |
| NPI Enumeration Date: | 10/07/2015 |
| NPI Last Update Date: | 10/07/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 332BC3200X |
| License Number: | 15226 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Suppliers |
| Taxonomy Classification: | Durable Medical Equipment & Medical Supplies |
| Taxonomy Specialization: | Customized Equipment |
| Taxonomy Definition: | |