Provider Demographics
NPI:1962414748
Name:GARRETT K PISKOR, DMD PC
Entity type:Organization
Organization Name:GARRETT K PISKOR, DMD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GARRETT
Authorized Official - Middle Name:K
Authorized Official - Last Name:PISKOR
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-547-4958
Mailing Address - Street 1:57 BEDFORD ST
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4500
Mailing Address - Country:US
Mailing Address - Phone:781-862-1900
Mailing Address - Fax:781-862-1817
Practice Address - Street 1:57 BEDFORD ST
Practice Address - Street 2:SUITE 208
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4500
Practice Address - Country:US
Practice Address - Phone:781-862-1900
Practice Address - Fax:781-862-1817
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15316126900000X
MA12217126900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes126900000XDental ProvidersDental Laboratory TechnicianGroup - Multi-Specialty