MEDICARE: PERYA PLLC

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	122300000X	Dentist

General Provider Information

NPI Number	:	1376367284
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PERYA PLLC

Provider Business Mailing Address
First Line	:	16915 SONOMA RDG
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78255-3804
Country	:	US
Telephone Number	:	949-232-5593
Fax Number	:

Provider Business Practice Location Address
First Line	:	8202 N LOOP 1604 W STE 101
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78249-2898
Country	:	US
Telephone Number	:	949-232-5593
Fax Number	:

Authorized Official
Title or Position	:	DENTIST/OWNER
Name	:	PEDRAM DOROUDGAR
Credential	:	DDS
Telephone Number	:	949-232-5593

Provider Enumeration Date	:	11/08/2024
Last Update Date	:	11/08/2024

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