MEDICARE: GARRETT K PISKOR, DMD PC

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	126900000X	Dental Laboratory Technician	12217	MA
2	126900000X	Dental Laboratory Technician	15316	MA

General Provider Information

NPI Number	:	1962414748
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GARRETT K PISKOR, DMD PC

Provider Business Mailing Address
First Line	:	57 BEDFORD ST
Second Line	:	SUITE 208
City	:	LEXINGTON
State	:	MA
Zip	:	02420-4500
Country	:	US
Telephone Number	:	781-862-1900
Fax Number	:	781-862-1817

Provider Business Practice Location Address
First Line	:	57 BEDFORD ST
Second Line	:	SUITE 208
City	:	LEXINGTON
State	:	MA
Zip	:	02420-4500
Country	:	US
Telephone Number	:	781-862-1900
Fax Number	:	781-862-1817

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GARRETT K PISKOR
Credential	:	DMD
Telephone Number	:	617-547-4958

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	01/14/2013

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