Provider Demographics
NPI:1053568709
Name:PERDOMO, VIRMARIS L (DMD)
Entity type:Individual
Prefix:DR
First Name:VIRMARIS
Middle Name:L
Last Name:PERDOMO
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 W 55TH ST
Mailing Address - Street 2:APT 1 I
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-4554
Mailing Address - Country:US
Mailing Address - Phone:212-203-3977
Mailing Address - Fax:
Practice Address - Street 1:1228 WANTAGH AVE
Practice Address - Street 2:# 102
Practice Address - City:WANTAGH
Practice Address - State:NY
Practice Address - Zip Code:11793-2209
Practice Address - Country:US
Practice Address - Phone:516-679-7978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-25
Last Update Date:2008-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053986-11223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics