Provider Demographics
NPI:1891811063
Name:PERIO INC
Entity Type:Organization
Organization Name:PERIO INC
Other - Org Name:DR. ROSS, NAGER AND PIERCE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:R
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:401-781-2742
Mailing Address - Street 1:67 JEFFERSON BOULVARD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02888-1053
Mailing Address - Country:US
Mailing Address - Phone:401-781-2742
Mailing Address - Fax:401-781-2740
Practice Address - Street 1:67 JEFFERSON BOULVARD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02888-1053
Practice Address - Country:US
Practice Address - Phone:401-781-2742
Practice Address - Fax:401-781-2740
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-21
Last Update Date:2011-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI6529140002Medicare NSC