Provider Demographics
NPI:1225181274
Name:PERGIOVANNI, EDWARD FRANK (DMD)
Entity type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:FRANK
Last Name:PERGIOVANNI
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825F CROMWELL AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKY HILL
Mailing Address - State:CT
Mailing Address - Zip Code:06067-3017
Mailing Address - Country:US
Mailing Address - Phone:860-721-9002
Mailing Address - Fax:860-721-9048
Practice Address - Street 1:825F CROMWELL AVE
Practice Address - Street 2:
Practice Address - City:ROCKY HILL
Practice Address - State:CT
Practice Address - Zip Code:06067-3017
Practice Address - Country:US
Practice Address - Phone:860-721-9002
Practice Address - Fax:860-721-9048
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT52511223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice