Provider Demographics
NPI:1659521631
Name:PERITORE, VICTOR ANTHONY (DDS, MSD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ANTHONY
Last Name:PERITORE
Suffix:
Gender:M
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 1:2400 WESTBOROUGH BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-5413
Mailing Address - Country:US
Mailing Address - Phone:650-871-1400
Mailing Address - Fax:
Practice Address - Street 1:2400 WESTBOROUGH BLVD STE 205
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-5413
Practice Address - Country:US
Practice Address - Phone:650-871-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-25
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA565281223E0200X
TX00252291223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics