Provider Demographics
NPI:1851832356
Name:EILERS FURGAL, PERICHOLE LYN (DDS)
Entity Type:Individual
Prefix:
First Name:PERICHOLE
Middle Name:LYN
Last Name:EILERS FURGAL
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 MOUNT AUBURN ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4046
Mailing Address - Country:US
Mailing Address - Phone:585-703-6046
Mailing Address - Fax:
Practice Address - Street 1:190 MOUNT AUBURN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4046
Practice Address - Country:US
Practice Address - Phone:585-703-6046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-16
Last Update Date:2017-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857310122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist