Provider Demographics
NPI:1639563430
Name:PERERA, IROSHINI JEANNE (DDS, MSD)
Entity Type:Individual
Prefix:
First Name:IROSHINI
Middle Name:JEANNE
Last Name:PERERA
Suffix:
Gender:F
Credentials:DDS, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 VAN NESS AVE APT 405
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-7802
Mailing Address - Country:US
Mailing Address - Phone:408-368-1608
Mailing Address - Fax:
Practice Address - Street 1:1255 WILLOW PASS RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-5218
Practice Address - Country:US
Practice Address - Phone:408-368-1608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-19
Last Update Date:2015-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA643691223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics