| Premier Family Dentistry | |
|
3024 Kingsbridge Ave Bronx NY 10463-5121 | |
| (718) 543-4747 | |
| (718) 884-6137 |
| Full Name | Premier Family Dentistry |
|---|---|
| Speciality | Clinic/Center |
| Location | 3024 Kingsbridge Ave, Bronx, New York |
| Authorized Official Name and Position | Gabriel Adeyemi Isioye (OWNER) |
| Authorized Official Contact | 7185434747 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Premier Family Dentistry 3024 Kingsbridge Ave Bronx NY 10463-5121 Ph: (718) 543-4747 | Premier Family Dentistry 3024 Kingsbridge Ave Bronx NY 10463-5121 Ph: (718) 543-4747 |
| NPI Number | 1679932818 |
|---|---|
| Provider Enumeration Date | 02/16/2016 |
| Last Update Date | 02/16/2016 |
| Medicare PECOS PAC ID | 2163713140 |
|---|---|
| Medicare Enrollment ID | O20160622001202 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1679932818 | NPI | - | NPPES |
| 02419776 | Medicaid | NY |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QD0000X | Clinic/center - Dental | 050241 (New York) | Primary |
| Provider Name | Gabriel Adeyemi Isioye |
|---|---|
| Provider Type | Practitioner - Oral Surgery |
| Provider Identifiers | NPI Number: 1942281829 PECOS PAC ID: 3072804053 Enrollment ID: I20160622001365 |
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