MEDICARE: PERICHOLE LYN EILERS FURGAL DDS

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	DN1857310	MA

General Provider Information

NPI Number	:	1851832356
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERICHOLE LYN EILERS FURGAL DDS

Provider Business Mailing Address
First Line	:	190 MOUNT AUBURN ST
Second Line	:
City	:	WATERTOWN
State	:	MA
Zip	:	02472-4046
Country	:	US
Telephone Number	:	585-703-6046
Fax Number	:

Provider Business Practice Location Address
First Line	:	190 MOUNT AUBURN ST
Second Line	:
City	:	WATERTOWN
State	:	MA
Zip	:	02472-4046
Country	:	US
Telephone Number	:	585-703-6046
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/16/2017
Last Update Date	:	03/16/2017

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