Provider Demographics
NPI:1235236043
Name:PERIODONTAL ASSOCIATES INC
Entity Type:Organization
Organization Name:PERIODONTAL ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CARY
Authorized Official - Middle Name:N
Authorized Official - Last Name:FEUERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:508-875-6185
Mailing Address - Street 1:661 FRANKLIN STREET
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01702-2900
Mailing Address - Country:US
Mailing Address - Phone:508-875-6185
Mailing Address - Fax:508-872-5745
Practice Address - Street 1:661 FRANKLIN STREET
Practice Address - Street 2:
Practice Address - City:FRAMINGHAM
Practice Address - State:MA
Practice Address - Zip Code:01702-2900
Practice Address - Country:US
Practice Address - Phone:508-875-6185
Practice Address - Fax:508-872-5745
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA156251223P0300X
MA159831223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0239OtherDELTA DENTAL