Organization
PERICO BACK BAY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. GARY M. REISER D.D.S. (MANAGING DOCTOR)
(617) 456-9714
Entity
Organization
Contact information
Practice address
400 COMMONWEALTH AVE. 3RD FLR., BOSTON, MA 02215
(617) 456-9714
(617) 266-9530
Mailing address
400 COMMONWEALTH AVE. 3RD FLR., BOSTON, MA 02215
(617) 456-9714
(617) 266-9530
Taxonomy
Speciality
Code
Description
License number
State
1223P0300X
Periodontics
Primary
—
MA
Other
Enumeration date
11/26/2013
Last updated
11/26/2013
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