# PREMIERE PLASTIC COSMETIC AND LASER SURGERY CENTER LLC

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

## Provider details

- **NPI number:** 1770631392
- **Authorized official:** DR. THOMAS PERCY M.D. (PRESIDENT)
- **Authorized official phone:** (937) 294-9255

## Contact information

- **Practice address:** 3533 SOUTHERN BLVD, SUITE 4400, KETTERING, OH 45429-1264
- **Practice address phone:** (937) 294-9255
- **Practice address fax:** (937) 294-9256
- **Mailing address:** 3533 SOUTHERN BLVD, SUITE 4400, KETTERING, OH 45429-1264
- **Mailing address phone:** (937) 294-9255
- **Mailing address fax:** (937) 294-9256

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 037634 | OH | Yes |

## Other

- **Enumeration date:** 01/08/2007
- **Last updated:** 12/28/2012