Provider Demographics
NPI:1750119293
Name:PREMIER FAMILY DENTISTRY LLC
Entity type:Organization
Organization Name:PREMIER FAMILY DENTISTRY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:MOHANNAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ABBOUSHI
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:973-879-8761
Mailing Address - Street 1:194 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07003-4394
Mailing Address - Country:US
Mailing Address - Phone:973-250-6400
Mailing Address - Fax:
Practice Address - Street 1:194 BROAD ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07003-4394
Practice Address - Country:US
Practice Address - Phone:973-250-6400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-25
Last Update Date:2024-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223D0001XDental ProvidersDentistDental Public HealthGroup - Single Specialty