Provider Demographics
NPI:1467864256
Name:THE PERIOCLINIC LLC
Entity Type:Organization
Organization Name:THE PERIOCLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR/MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:HISHAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:NASR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:504-831-0800
Mailing Address - Street 1:337 METAIRIE RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-4338
Mailing Address - Country:US
Mailing Address - Phone:504-831-0800
Mailing Address - Fax:504-831-0866
Practice Address - Street 1:337 METAIRIE RD
Practice Address - Street 2:SUITE 301
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-4338
Practice Address - Country:US
Practice Address - Phone:504-831-0800
Practice Address - Fax:504-831-0866
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA48321223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty