Provider Demographics
NPI:1154462695
Name:PERROTT, ROBERT D (DMD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:D
Last Name:PERROTT
Suffix:
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 1:7200 BRISTLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BOARDMAN
Mailing Address - State:OH
Mailing Address - Zip Code:44512-5111
Mailing Address - Country:US
Mailing Address - Phone:330-726-0090
Mailing Address - Fax:330-726-1002
Practice Address - Street 1:7200 BRISTLEWOOD DR
Practice Address - Street 2:
Practice Address - City:BOARDMAN
Practice Address - State:OH
Practice Address - Zip Code:44512-5111
Practice Address - Country:US
Practice Address - Phone:330-726-0090
Practice Address - Fax:330-726-1002
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH189221223G0001X
PADS026257L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice