MEDICARE: TRAVIS DANIEL PERO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	30.026822	OH

General Provider Information

NPI Number	:	1003545021
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRAVIS DANIEL PERO

Provider Business Mailing Address
First Line	:	182 PARKWOOD AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43203-1780
Country	:	US
Telephone Number	:	330-714-7616
Fax Number	:

Provider Business Practice Location Address
First Line	:	182 PARKWOOD AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43203-1780
Country	:	US
Telephone Number	:	330-714-7616
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2022
Last Update Date	:	06/06/2022

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Directions to “ TRAVIS DANIEL PERO ” Practice Location

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