Provider Demographics
NPI:1366099517
Name:PREMIER CHOICE DENTAL PLLC
Entity type:Organization
Organization Name:PREMIER CHOICE DENTAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:W
Authorized Official - Last Name:BENNION
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MD
Authorized Official - Phone:406-671-0496
Mailing Address - Street 1:8707 JACKRABBIT LN
Mailing Address - Street 2:
Mailing Address - City:BELGRADE
Mailing Address - State:MT
Mailing Address - Zip Code:59714-8995
Mailing Address - Country:US
Mailing Address - Phone:406-671-0496
Mailing Address - Fax:
Practice Address - Street 1:8707 JACKRABBIT LN
Practice Address - Street 2:
Practice Address - City:BELGRADE
Practice Address - State:MT
Practice Address - Zip Code:59714-8995
Practice Address - Country:US
Practice Address - Phone:406-671-0496
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty