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Organization
PREMIER DENTAL
Active
Organization
PREMIER DENTAL
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. TOM Y LEE DDS (CEO)
(817) 733-5469
Entity
Organization
Contact information
Practice address
1514 WHITE BEAR AVE N, B, SAINT PAUL, MN 55106-1624
(817) 733-5469
Mailing address
1514 WHITE BEAR AVE N, B, SAINT PAUL, MN 55106-1624
(817) 733-5469
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
D12859
MN
Other
Enumeration date
02/27/2013
Last updated
02/27/2013
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