Provider Demographics
NPI:1356484307
Name:PERIODONTAL SPECIALISTS INC.
Entity Type:Organization
Organization Name:PERIODONTAL SPECIALISTS INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:W
Authorized Official - Last Name:GUIRGUIS
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MSD
Authorized Official - Phone:440-835-8883
Mailing Address - Street 1:29160 CENTER RIDGE RD
Mailing Address - Street 2:SUITE J
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-5225
Mailing Address - Country:US
Mailing Address - Phone:440-835-8883
Mailing Address - Fax:440-835-9395
Practice Address - Street 1:29160 CENTER RIDGE RD
Practice Address - Street 2:SUITE J
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-5225
Practice Address - Country:US
Practice Address - Phone:440-835-8883
Practice Address - Fax:440-835-9395
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH189581223P0300X
261QS0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0112XAmbulatory Health Care FacilitiesClinic/CenterOral and Maxillofacial Surgery
No1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty