MEDICARE: PERIOIMPLANT ASSOCIATES

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	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1154331825
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERIOIMPLANT ASSOCIATES

Provider Business Mailing Address
First Line	:	3620 BLACKISTON BLVD
Second Line	:	SUITE 150
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-8529
Country	:	US
Telephone Number	:	812-948-0408
Fax Number	:	812-948-0409

Provider Business Practice Location Address
First Line	:	3620 BLACKISTON BLVD
Second Line	:	SUITE 150
City	:	NEW ALBANY
State	:	IN
Zip	:	47150-8529
Country	:	US
Telephone Number	:	812-948-0408
Fax Number	:	812-948-0409

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. GREGORY J. ALBRIGHT
Credential	:	D.M.D.
Telephone Number	:	502-897-9417

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	08/03/2010

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