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General NPI Number Information
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NPI Number | 1376367284
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Entity Type | Organization
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Legal Business Name | PERYA PLLC
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Dates
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Enumeration Date | 11/08/2024
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Last Update Date | 11/08/2024
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Provider Practice Location Address
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Address Line | 8202 N LOOP 1604 W STE 101
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City | SAN ANTONIO
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State | TX
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Zip | 78249-2898
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Country | US
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Telephone | 949-232-5593
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Fax |
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Provider Business Mailing Address
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Address Line | 16915 SONOMA RDG
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City | SAN ANTONIO
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State | TX
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Zip | 78255-3804
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Country | US
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Telephone | 949-232-5593
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Fax |
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Authorized Official
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Title or Position | DENTIST/OWNER
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Name | PEDRAM DOROUDGAR
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Credential | DDS
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Telephone | 949-232-5593
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number |
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License Number State |
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