Provider Demographics
NPI:1164073904
Name:PERLOT, KIMBERLY ANN (EPDH, RDH)
Entity Type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:ANN
Last Name:PERLOT
Suffix:
Gender:F
Credentials:EPDH, RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 HAWTHORNE AVE
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97301
Mailing Address - Country:US
Mailing Address - Phone:800-525-6800
Mailing Address - Fax:503-581-0043
Practice Address - Street 1:1555 S HIGHWAY 97 STE 102
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-9652
Practice Address - Country:US
Practice Address - Phone:800-525-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-24
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDT0010125J00000X
ORH7180124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes125J00000XDental ProvidersDental Therapist
No124Q00000XDental ProvidersDental Hygienist