Provider Demographics
NPI:1518309640
Name:PERDICHIZZI, JUSTIN T (DMD)
Entity Type:Individual
Prefix:DR
First Name:JUSTIN
Middle Name:T
Last Name:PERDICHIZZI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2391 NORTH TENAYA WAY
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-0458
Mailing Address - Country:US
Mailing Address - Phone:702-228-7575
Mailing Address - Fax:702-240-6373
Practice Address - Street 1:2391 NORTH TENAYA WAY
Practice Address - Street 2:SUITE 206
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-0458
Practice Address - Country:US
Practice Address - Phone:702-228-7575
Practice Address - Fax:702-240-6373
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2013-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV6340122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist