Provider Demographics
NPI:1427430891
Name:PERERA, AUSTIN (DMD)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:
Last Name:PERERA
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 1:700 ATTUCKS LN UNIT 2C
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-1809
Mailing Address - Country:US
Mailing Address - Phone:508-771-4320
Mailing Address - Fax:
Practice Address - Street 1:700 ATTUCKS LN
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-1809
Practice Address - Country:US
Practice Address - Phone:508-771-4320
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-22
Last Update Date:2019-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN18571111223E0200X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentist
Yes1223E0200XDental ProvidersDentistEndodonticsGroup - Single Specialty