Provider Demographics
NPI:1669797676
Name:PERA DENTAL CARE
Entity type:Organization
Organization Name:PERA DENTAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DDS
Authorized Official - Prefix:DR
Authorized Official - First Name:VEZIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:SARAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-928-9999
Mailing Address - Street 1:590 WEST 172ND ST
Mailing Address - Street 2:APT 1F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-2031
Mailing Address - Country:US
Mailing Address - Phone:212-928-9999
Mailing Address - Fax:
Practice Address - Street 1:590 W 172ND ST APT 1F
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-2031
Practice Address - Country:US
Practice Address - Phone:212-928-9999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-01
Last Update Date:2010-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0492341223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty