Provider Demographics
NPI:1396841854
Name:PERIONORTH, P.C.
Entity Type:Organization
Organization Name:PERIONORTH, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:I
Authorized Official - Last Name:DOBEN
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:978-922-7666
Mailing Address - Street 1:56 DODGE ST
Mailing Address - Street 2:
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-1786
Mailing Address - Country:US
Mailing Address - Phone:978-966-7666
Mailing Address - Fax:978-921-1714
Practice Address - Street 1:56 DODGE ST
Practice Address - Street 2:
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-1786
Practice Address - Country:US
Practice Address - Phone:978-966-7666
Practice Address - Fax:978-921-1714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA119091223P0300X
MA207971223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty