Provider Demographics
NPI:1447781489
Name:PREMIER DENTISTRY OF BOYNTON BEACH
Entity type:Organization
Organization Name:PREMIER DENTISTRY OF BOYNTON BEACH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CASEL
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:561-244-7022
Mailing Address - Street 1:1001 W INDIANTOWN RD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:JUPITER
Mailing Address - State:FL
Mailing Address - Zip Code:33458-6830
Mailing Address - Country:US
Mailing Address - Phone:561-244-7022
Mailing Address - Fax:561-244-7027
Practice Address - Street 1:10075 S JOG RD
Practice Address - Street 2:SUITE #102
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3535
Practice Address - Country:US
Practice Address - Phone:561-244-7022
Practice Address - Fax:561-747-8826
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-22
Last Update Date:2017-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Multi-Specialty