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General NPI Number Information
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NPI Number | 1184381345
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Entity Type | Organization
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Legal Business Name | PERICO, PC
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Dates
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Enumeration Date | 11/23/2021
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Last Update Date | 11/23/2021
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Provider Practice Location Address
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Address Line | 300 BOYLSTON ST. SUITE 202
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City | CHESTNUT HILL
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State | MA
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Zip | 02467
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Country | US
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Telephone | 617-340-6097
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Fax |
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Provider Business Mailing Address
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Address Line | 90 HUMPHREY ST.
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City | SWAMPSCOTT
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State | MA
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Zip | 01907-2542
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Country | US
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Telephone | 781-596-2220
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Fax |
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Authorized Official
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Title or Position | PRACTICE ADMINISTRATOR
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Name | NANCY M. GRIFFIN
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Credential |
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Telephone | 781-596-2220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number |
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License Number State |
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