| Premier Dental Group Pllc | |
|
9420 Forestwood Ln Ste 201 Manassas VA 20110-4758 | |
| (617) 943-8812 | |
| Not Available |
| Full Name | Premier Dental Group Pllc |
|---|---|
| Speciality | Dentist - Pediatric Dentistry |
| Location | 9420 Forestwood Ln Ste 201, Manassas, Virginia |
| Authorized Official Name and Position | Payam Amirsayafi (OWNER) |
| Authorized Official Contact | 6179438812 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Dental Group Pllc 9420 Forestwood Ln Ste 201 Manassas VA 20110-4758 Ph: () - | Premier Dental Group Pllc 9420 Forestwood Ln Ste 201 Manassas VA 20110-4758 Ph: (617) 943-8812 |
| NPI Number | 1063971281 |
|---|---|
| Provider Enumeration Date | 03/18/2019 |
| Last Update Date | 03/18/2019 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1063971281 | NPI | - | NPPES |
| 1881968204 | Medicaid | VA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223D0004X | Dentist - Dentist Anesthesiologist | (* (Not Available)) | Secondary |
| 1223P0221X | Dentist - Pediatric Dentistry | (* (Not Available)) | Primary |
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