Provider Demographics
NPI:1558616334
Name:PERISHO, JOSHUA (DDS)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:
Last Name:PERISHO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7210 GREENHAVEN DR
Mailing Address - Street 2:STE D
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95831-3576
Mailing Address - Country:US
Mailing Address - Phone:916-421-4686
Mailing Address - Fax:
Practice Address - Street 1:7210 GREENHAVEN DR
Practice Address - Street 2:STE D
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95831-3576
Practice Address - Country:US
Practice Address - Phone:916-421-4686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-18
Last Update Date:2013-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61520122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist