Provider Demographics
NPI:1265982292
Name:PERI, KEERTHI CHANDRIKA (DMD)
Entity type:Individual
Prefix:
First Name:KEERTHI
Middle Name:CHANDRIKA
Last Name:PERI
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2C OLD COLONY DR
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-1073
Mailing Address - Country:US
Mailing Address - Phone:339-927-5033
Mailing Address - Fax:
Practice Address - Street 1:26 WOOD ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01851-1519
Practice Address - Country:US
Practice Address - Phone:978-458-5544
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857448122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist