Provider Demographics
NPI:1609060763
Name:PERSKY, NEAL
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:
Last Name:PERSKY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4301 W WILLIAM CANNON
Mailing Address - Street 2:BLDG B SUITE 240
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749
Mailing Address - Country:US
Mailing Address - Phone:512-892-7800
Mailing Address - Fax:512-892-7805
Practice Address - Street 1:4301 W WILLIAM CANNON
Practice Address - Street 2:BLDG B SUITE 240
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749
Practice Address - Country:US
Practice Address - Phone:512-892-7800
Practice Address - Fax:512-892-7805
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22747122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist