# PENN PREMIER DENTAL, INC.

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

## Provider details

- **NPI number:** 1861645145
- **Authorized official:** DR. SHAHRAM SHAMLOO DMD (VICE PRESIDENT)
- **Authorized official phone:** (610) 363-5810

## Contact information

- **Practice address:** 194 EXTON SQUARE MALL, EXTON, PA 19341-2440
- **Practice address phone:** (610) 363-5810
- **Practice address fax:** (610) 594-0667
- **Mailing address:** 194 EXTON SQUARE MALL, EXTON, PA 19341-2440
- **Mailing address phone:** (610) 363-5810
- **Mailing address fax:** (610) 594-0667

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 122300000X | Dentist | DS036832 | PA | — |
| 122300000X | Dentist | DS036955 | PA | Yes |
| 122300000X | Dentist | DS037059 | PA | — |
| 122300000X | Dentist | DS037327 | PA | — |
| 1223E0200X | Endodontics | DS037059 | PA | — |
| 1223P0221X | Pediatric Dentistry | DS023283Y | PA | — |
| 1223P0300X | Periodontics | DS036138 | PA | — |
| 1223X0400X | Orthodontics and Dentofacial Orthopedics Dentistry | DS036830 | PA | — |

## Other

- **Enumeration date:** 10/30/2008
- **Last updated:** 03/09/2010