Provider Demographics
NPI:1003012501
Name:PERKO, JAY R I (DDS)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:R
Last Name:PERKO
Suffix:I
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 S GARDEN ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-2810
Mailing Address - Country:US
Mailing Address - Phone:559-732-5658
Mailing Address - Fax:559-732-1958
Practice Address - Street 1:426 S GARDEN ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-2810
Practice Address - Country:US
Practice Address - Phone:559-732-5658
Practice Address - Fax:559-732-1958
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA240471223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics