MEDICARE: PLYMOUTH PERIO 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	1223P0300X	Periodontics

General Provider Information

NPI Number	:	1770433732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PLYMOUTH PERIO PLLC

Provider Business Mailing Address
First Line	:	128 SUMNER ST
Second Line	:
City	:	MILTON
State	:	MA
Zip	:	02186-2555
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 RESNIK RD STE 304
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-4883
Country	:	US
Telephone Number	:	508-927-1486
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	SAMAR SHAIKH
Credential	:	DMD
Telephone Number	:	508-927-1486

Provider Enumeration Date	:	01/30/2026
Last Update Date	:	01/30/2026

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