Provider Demographics
NPI:1114790508
Name:PERIO STUDIO ASSOCIATES PC
Entity Type:Organization
Organization Name:PERIO STUDIO ASSOCIATES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:IRINA
Authorized Official - Middle Name:F
Authorized Official - Last Name:DRAGAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:347-249-1729
Mailing Address - Street 1:10 TREMONT ST STE 402
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02108-2062
Mailing Address - Country:US
Mailing Address - Phone:617-523-2459
Mailing Address - Fax:
Practice Address - Street 1:10 TREMONT ST STE 402
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02108-2062
Practice Address - Country:US
Practice Address - Phone:617-523-2459
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-06
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental