Provider Demographics
NPI:1306126735
Name:PERICO IMPLANTS NORTH
Entity type:Organization
Organization Name:PERICO IMPLANTS NORTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-596-2220
Mailing Address - Street 1:90 HUMPHREY ST.
Mailing Address - Street 2:
Mailing Address - City:SWAMPSCOTT
Mailing Address - State:MA
Mailing Address - Zip Code:01907-2542
Mailing Address - Country:US
Mailing Address - Phone:781-596-2220
Mailing Address - Fax:781-598-8050
Practice Address - Street 1:95 WALKERS BROOK DR.
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-3238
Practice Address - Country:US
Practice Address - Phone:781-245-8811
Practice Address - Fax:781-694-3596
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-17
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN129611223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223P0300XDental ProvidersDentistPeriodonticsGroup - Single Specialty