Organization
PREMIER DENTAL P C
Active
Organization subpart
No
Provider details
NPI number
Authorized official
POLINA P SIMANOVICH (DENTIST/PROSTHODONTIST)
(203) 235-1415
Entity
Organization
Contact information
Practice address
727 BROAD ST, MERIDEN, CT 06450-4341
(203) 235-1415
Mailing address
727 BROAD ST, MERIDEN, CT 06450-4341
Taxonomy
Speciality
Code
Description
License number
State
1223P0700X
Prosthodontics
10452
CT
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
332BC3200X
Customized Equipment (DME)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
7807300001
PTAN MEDICARE NSC
CT
Enumeration date
07/19/2014
Last updated
05/03/2023
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