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NPI Code Detail

MEDICARE: GUSTAVO PERDOMO, DMD, LLC

MEDICARE: GUSTAVO PERDOMO, DMD, LLC
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
1122300000XDentist21628MA

General Provider Information

NPI Number : 1700052651
Entity Type Code : Organization
Provider Name (Legal Business Name) : GUSTAVO PERDOMO, DMD, LLC
Provider Business Mailing Address
First Line : 330 WASHINGTON ST
Second Line :
City : WEYMOUTH
State : MA
Zip : 02188-2932
Country : US
Telephone Number : 781-335-5300
Fax Number :
Provider Business Practice Location Address
First Line : 330 WASHINGTON ST
Second Line :
City : WEYMOUTH
State : MA
Zip : 02188-2932
Country : US
Telephone Number : 781-335-5300
Fax Number :
Authorized Official
Title or Position : DENTIST
Name : DR. GUSTAVO PERDOMO
Credential : DMD
Telephone Number : 781-335-5300
Provider Enumeration Date : 05/01/2008
Last Update Date : 05/01/2008

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