1700081072 NPI number — GREG J. PERENTIS DDS. PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700081072 NPI number — GREG J. PERENTIS DDS. PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREG J. PERENTIS DDS. PLLC
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:
6
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:
1700081072
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5310 NC HIGHWAY 55
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
DURHAM
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
27713-7813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
919-361-1998
Provider Business Mailing Address Fax Number:
919-484-7432

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5310 NC HIGHWAY 55
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27713-7813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-361-1998
Provider Business Practice Location Address Fax Number:
919-484-7432
Provider Enumeration Date:
06/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PERENTIS
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
DENTIST
Authorized Official Telephone Number:
919-361-1998

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  7244 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 89014R5 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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