Provider Demographics
NPI:1083752505
Name:PERDUE, WILLIAM LUKE SR (DMD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:LUKE
Last Name:PERDUE
Suffix:SR
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:PO BOX 231
Mailing Address - Street 2:
Mailing Address - City:CHESTERFIELD
Mailing Address - State:SC
Mailing Address - Zip Code:29709
Mailing Address - Country:US
Mailing Address - Phone:843-623-2333
Mailing Address - Fax:843-623-7905
Practice Address - Street 1:220 SOUTH CRAIG ST
Practice Address - Street 2:
Practice Address - City:CHESTERFIELD
Practice Address - State:SC
Practice Address - Zip Code:29709
Practice Address - Country:US
Practice Address - Phone:843-623-2333
Practice Address - Fax:843-623-7905
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC2817122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC228177Medicaid