Organization
PREMIER DENTAL PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
POTA A RAKES DDS (OWNER)
(402) 981-2996
Entity
Organization
Contact information
Practice address
22801 NEWMAN ST, DEARBORN, MI 48124-2200
(313) 274-8522
(313) 274-5396
Mailing address
22801 NEWMAN ST, DEARBORN, MI 48124-2200
(313) 274-8522
(313) 274-5396
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
2901020370
MI
Other
Enumeration date
08/09/2011
Last updated
09/23/2013
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