Organization
PREMIERE PLASTIC COSMETIC AND LASER SURGERY CENTER LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. THOMAS PERCY M.D. (PRESIDENT)
(937) 294-9255
Entity
Organization
Contact information
Practice address
3533 SOUTHERN BLVD, SUITE 4400, KETTERING, OH 45429-1264
(937) 294-9255
(937) 294-9256
Mailing address
3533 SOUTHERN BLVD, SUITE 4400, KETTERING, OH 45429-1264
(937) 294-9255
(937) 294-9256
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
037634
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
3035227
—
OH
Enumeration date
01/08/2007
Last updated
12/28/2012
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