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PREMIER PERIODONTICS LLC NPI 1770911976


NPI Information

NPI: 1770911976
Provider Name: PREMIER PERIODONTICS LLC
Classification: Dentist - 1223P0300X
Entity Type: Organization

Specialization: Periodontics

CLIA Number: 52D2212705

Address:
2933 W LAYTON AVE
GREENFIELD, WI
ZIP 53221
Phone: (414) 282-2642
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PREMIER PERIODONTICS LLC is a periodontics dentist in Greenfield, WI. The provider is that specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. PREMIER PERIODONTICS LLC NPI is 1770911976. The provider is registered as an organization entity type and is a multiple single specialty group.

The provider's business location address is:

2933 W LAYTON AVE
GREENFIELD, WI
ZIP 53221-626
Phone: (414) 282-2642
Fax: (414) 282-1952

The provider's authorized official is Genevieve E Poppe .
The authorized official title is Partner and has the following contact phone number (608) 358-3370.

The CLIA number assigned to this NPI record is 52D2212705 - practitioner other with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 10/24/2013 and was last updated on 10/24/2013.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
11223P0300XDentistPeriodontics7160-15WISCONSINNo
21223P0300XDentistPeriodontics5001847-15WISCONSINYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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