Provider Demographics
NPI:1376180828
Name:PERIKYMATA, PLLC
Entity Type:Organization
Organization Name:PERIKYMATA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:347-503-9121
Mailing Address - Street 1:15 COLUMBIA RD STE 2
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE
Mailing Address - State:MA
Mailing Address - Zip Code:02359-1841
Mailing Address - Country:US
Mailing Address - Phone:781-499-5438
Mailing Address - Fax:
Practice Address - Street 1:15 COLUMBIA RD STE 2
Practice Address - Street 2:
Practice Address - City:PEMBROKE
Practice Address - State:MA
Practice Address - Zip Code:02359-1841
Practice Address - Country:US
Practice Address - Phone:781-499-5438
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-03
Last Update Date:2019-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty