Provider Demographics
NPI:1073779013
Name:PERKINS, JACK III (DMD)
Entity Type:Individual
Prefix:DR
First Name:JACK
Middle Name:
Last Name:PERKINS
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 SCHERM RD
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6022
Mailing Address - Country:US
Mailing Address - Phone:270-684-0011
Mailing Address - Fax:270-683-2210
Practice Address - Street 1:745 SCHERM RD
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6022
Practice Address - Country:US
Practice Address - Phone:270-684-0011
Practice Address - Fax:270-683-2210
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY86711223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice