# PREMIER DENTAL PC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1366721292
- **Authorized official:** POTA A RAKES DDS (OWNER)
- **Authorized official phone:** (402) 981-2996

## Contact information

- **Practice address:** 22801 NEWMAN ST, DEARBORN, MI 48124-2200
- **Practice address phone:** (313) 274-8522
- **Practice address fax:** (313) 274-5396
- **Mailing address:** 22801 NEWMAN ST, DEARBORN, MI 48124-2200
- **Mailing address phone:** (313) 274-8522
- **Mailing address fax:** (313) 274-5396

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | 2901020370 | MI | Yes |

## Other

- **Enumeration date:** 08/09/2011
- **Last updated:** 09/23/2013