Provider Demographics
NPI:1932393840
Name:PISKOR, GARRETT KEVIN (DMD)
Entity Type:Individual
Prefix:MR
First Name:GARRETT
Middle Name:KEVIN
Last Name:PISKOR
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:57 BEDFORD ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4500
Mailing Address - Country:US
Mailing Address - Phone:781-862-1900
Mailing Address - Fax:781-862-1817
Practice Address - Street 1:57 BEDFORD ST
Practice Address - Street 2:SUITE 208
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4500
Practice Address - Country:US
Practice Address - Phone:781-862-1900
Practice Address - Fax:781-862-1817
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-04
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15316122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist