PERICO BACK BAY, LLC (NPI# 1699105734) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1699105734 |
| Entity Type | Organization |
| Organization Name | PERICO BACK BAY, LLC |
| Practice Address |
400 Commonwealth Ave. 3rd Flr. Boston MA 02215 |
| Practice Telephone | 6174569714 |
| Practice Fax Number | 6172669530 |
| Mailing Telephone | 6174569714 |
| Mailing Fax Number | 6172669530 |
| Enumeration Date | 2013-11-26 |
| Last Update Date | 2013-11-26 |
| Authorized Official Name | DR. GARY M. REISER (MANAGING DOCTOR) |
| Authorized Official Telephone | 6174569714 |
| Authorized Official Credential | D.D.S. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223P0300X |
Dentist Specialization: Periodontics |
MA | Dental Providers |
| Street Address |
400 COMMONWEALTH AVE. 3RD FLR. |
| City | BOSTON |
| State | MA |
| Zip Code | 02215 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1336746775 | Lee T Gernon-lakin | Physician Assistant | 202 Robinson Hall, 360 Huntington Ave, Boston, MA 02215 | 2020-10-08 |
| 1821695933 | Matthew John Needham | Student in an Organized Health Care Education/Training Program | 330 Brookline Ave, Yamins 2nd Floor, Department of Anesthesia, Boston, MA 02215 | 2020-10-02 |
| 1114533866 | Cdg Back Bay LLC | Clinic/Center | 400 Commonwealth Ave 3rd Floor, Boston, MA 02215 | 2020-09-18 |
| 1619595105 | Natasha Larocque | Radiology | 330 Brookline Avenue, Sherman 231, Beth Israel Deacones, Radiology Education Office, Boston, MA 02215 | 2020-07-10 |
| 1538783089 | Yutsz Cherng | Counselor | 870r Commonwealth Avenue, Boston, MA 02215 | 2020-06-01 |
| 1306495924 | Anthony Rosellini | Psychologist | 900 Commonwealth Avenue (east), 2nd Floor, Boston, MA 02215 | 2019-09-06 |
| 1427605278 | Liana Zucco | Student in an Organized Health Care Education/Training Program | Beth Israel Deaconess Medical Centre, Dept Anesthesia, 330 Brookline Ave, Ya-02q02, Boston, MA 02215 | 2019-08-26 |
| 1831759430 | Brian William Hayes | Radiology | 330 Brookline Avenue, Beth Israel Deaconess Medical Cen, Boston, MA 02215 | 2019-06-17 |
| 1396304358 | Elizabeth Hai Yen Du | Student in an Organized Health Care Education/Training Program | Beth Israel Deaconess Medical Center, Department of Rad, 330 Brookline Avenue, Boston, MA 02215 | 2019-06-12 |
| 1922665439 | Corey Shaphard Miller | Student in an Organized Health Care Education/Training Program | 300 Brookline Avenue, Bidmc, Dana 501, Boston, MA 02215 | 2019-05-21 |
| Find all providers in zip 02215 | ||||
| Taxonomy Code | 1223P0300X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Periodontics |
| That specialty of dentistry which encompasses the prevention, diagnosis and treatment of diseases of the supporting and surrounding tissues of the teeth or their substitutes and the maintenance of the health, function and esthetics of these structures and tissues. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1871134833 | Supontep Teerakanok | Dentist | Henry Goldman School of Dental Medicine, 635 Albany St, Boston, MA 02118 | 2019-10-01 |
| 1437700218 | Mansour Alasiri | Dentist | 650 Albany St Ste 341, Boston, MA 02118-2518 | 2019-09-24 |
| 1508417338 | Bushra Aljahdali | Dentist | 650 Albany St Fl 3, Boston, MA 02118-2518 | 2019-09-23 |
| 1043863533 | Ricardo Lazaro Pascual | Dentist | 1 Kneeland St Dept, Boston, MA 02111-1527 | 2019-07-23 |
| 1992294979 | Smile Design Boston | Dentist | 21 Custom House St Ste 110, Boston, MA 02110-3525 | 2018-05-06 |
| 1245739291 | Maryam A Alsendi | Dentist | 100 E Newton St Ste G217, Boston, MA 02118-2308 | 2018-02-05 |
| 1528590783 | Rayan Al Edreesi | Dentist | 100 E Netwton St, Suite G-217, Boston, MA 02118 | 2017-03-28 |
| 1013457290 | Majed Khalid M Alshehri | Dentist | 100 East Newton Street Boston, Boston, MA 02118 | 2017-03-07 |
| 1639429525 | Majdi Ahmed Aladmawy | Dentist | 1 Kneeland St, Dhs 15, Boston, MA 02111 | 2012-09-18 |
| 1467702373 | Zuhair Natto | Dentist | One Kneeland St, Dhs 15th Floor, Boston, MA 02111 | 2012-09-18 |
| Find all providers in BOSTON | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.