Provider Demographics
NPI:1457429110
Name:PERINSKY, VICTORIA (DMD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:
Last Name:PERINSKY
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 1:495 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1007
Mailing Address - Country:US
Mailing Address - Phone:617-783-0500
Mailing Address - Fax:617-783-5514
Practice Address - Street 1:495 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:BRIGHTON
Practice Address - State:MA
Practice Address - Zip Code:02135-1007
Practice Address - Country:US
Practice Address - Phone:617-783-0500
Practice Address - Fax:617-987-8222
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA205661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1301446Medicaid
MA1320882Medicaid