Provider Demographics
NPI:1376367284
Name:PERYA PLLC
Entity type:Organization
Organization Name:PERYA PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEDRAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DOROUDGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:949-232-5593
Mailing Address - Street 1:16915 SONOMA RDG
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78255-3804
Mailing Address - Country:US
Mailing Address - Phone:949-232-5593
Mailing Address - Fax:
Practice Address - Street 1:8202 N LOOP 1604 W STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-2898
Practice Address - Country:US
Practice Address - Phone:949-232-5593
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty