Provider Demographics
NPI:1699182931
Name:PERIODONTAL HEALTH CARE P.C.
Entity Type:Organization
Organization Name:PERIODONTAL HEALTH CARE P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT AND OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHIH MEI
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHIANG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS, MS
Authorized Official - Phone:978-989-0777
Mailing Address - Street 1:13 BRANCH ST
Mailing Address - Street 2:PERIODONTAL HEALTH CARE P.C., SUITE 212
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844-1975
Mailing Address - Country:US
Mailing Address - Phone:978-989-0777
Mailing Address - Fax:
Practice Address - Street 1:13 BRANCH ST
Practice Address - Street 2:PERIODONTAL HEALTH CARE P.C., SUITE 212
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844-1975
Practice Address - Country:US
Practice Address - Phone:978-989-0777
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PERIODONTAL HEALTH CARE P.C
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA19421302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization