Provider Demographics
NPI:1790837250
Name:PERENTIS, GREGORY JOSEPH (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:JOSEPH
Last Name:PERENTIS
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:5310 NC HIGHWAY 55
Mailing Address - Street 2:SUITE 103
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-7813
Mailing Address - Country:US
Mailing Address - Phone:919-361-1998
Mailing Address - Fax:919-484-7432
Practice Address - Street 1:5310 NC HIGHWAY 55
Practice Address - Street 2:SUITE 103
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-7813
Practice Address - Country:US
Practice Address - Phone:919-361-1998
Practice Address - Fax:919-484-7432
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC72441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice