1205239373 NPI number — PERIHEALTH LLC

Table of content: DR. THOMAS JOSEPH CANAAN DDS (NPI 1104896398)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205239373 NPI number — PERIHEALTH LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERIHEALTH LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205239373
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3450 W 84TH ST
Provider Second Line Business Mailing Address:
103-A
Provider Business Mailing Address City Name:
MIAMI LAKES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33018-4924
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
305-921-9535
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3450 W 84TH ST
Provider Second Line Business Practice Location Address:
103-A
Provider Business Practice Location Address City Name:
MIAMI LAKES
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33018-4924
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-921-9535
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VALBUENA
Authorized Official First Name:
DIANA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
305-921-9535

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251F00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251J00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)