# PREMIER DENTAL OF EDGMONT SQUARE LLC

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

## Provider details

- **NPI number:** 1801327002
- **Authorized official:** MIKE COLE (VP INSURANCE PLAN MANAGEMENT)
- **Authorized official phone:** (941) 955-3150

## Contact information

- **Practice address:** 4753 W CHESTER PIKE, NEWTOWN SQUARE, PA 19073-2212
- **Practice address phone:** (484) 424-0078
- **Mailing address:** 4753 W CHESTER PIKE, NEWTOWN SQUARE, PA 19073-2212
- **Mailing address phone:** (484) 424-0078

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | — | PA | Yes |

## Other

- **Enumeration date:** 03/21/2017
- **Last updated:** 04/24/2017