Gustavo Perdomo DMD PC

Primary specialty

DentistTaxonomy code 122300000X

Legal business name

GUSTAVO PERDOMO DMD PC

Practice address

1996 Centre St Ste 201
West Roxbury, MA 02132-3330

Phone

(508) 250-6936

NPI assigned

Aug 9, 2018

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Thiago Soares

Title

Administrator

Phone

(508) 250-6936

Specialties & licenses 1

Addresses

Other names 1

• Reliant Dental Group Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1533772800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1533772800000",
    "number": "1578042669",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1996 CENTRE ST STE 201",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021323330",
            "telephone_number": "508-250-6936"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1996 CENTRE ST STE 201",
            "city": "WEST ROXBURY",
            "state": "MA",
            "postal_code": "021323330",
            "telephone_number": "508-250-6936"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUSTAVO PERDOMO DMD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-08-09",
        "last_updated": "2018-08-09",
        "status": "A",
        "authorized_official_last_name": "SOARES",
        "authorized_official_first_name": "THIAGO",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "508-250-6936"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Dentist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Reliant Dental Group",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sarah Clark Grudberg, MD
• Joseph M Guarino, D.M.D.
• Ali Guermazi, MD
• Erik Kevin Guilfoyle
• Yanchi Guo, OD
• Emily Hagen, PT, DPT
• Ildiko Halasz, M.D.
• Emily Louise Haley, FNP
• Pauline Chen Halsey, M.D.
• Zhaleh Jolle Hami, D.M.D.

• Dentist in West Roxbury, MA
• Providers in West Roxbury, MA by specialty
• Dentist in Massachusetts

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.