Healthcare Provider Details

I. General information

NPI: 1396841854
Provider Name (Legal Business Name): PERIONORTH, P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

56 DODGE ST
BEVERLY MA
01915-1786
US

IV. Provider business mailing address

56 DODGE ST
BEVERLY MA
01915-1786
US

V. Phone/Fax

Practice location:
  • Phone: 978-966-7666
  • Fax: 978-921-1714
Mailing address:
  • Phone: 978-966-7666
  • Fax: 978-921-1714

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number20797
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number11909
License Number StateMA

VIII. Authorized Official

Name: DR. DOUGLAS I DOBEN
Title or Position: PRESIDENT
Credential: D.M.D.
Phone: 978-922-7666