Provider Demographics
NPI:1174668156
Name:PERALA, DENNIS GENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:GENE
Last Name:PERALA
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 1:8070 SW HALL BLVD
Mailing Address - Street 2:#200
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97008-6419
Mailing Address - Country:US
Mailing Address - Phone:503-644-1110
Mailing Address - Fax:503-641-6431
Practice Address - Street 1:8070 SW HALL BLVD
Practice Address - Street 2:#200
Practice Address - City:BEAVERTON
Practice Address - State:OR
Practice Address - Zip Code:97008-6419
Practice Address - Country:US
Practice Address - Phone:503-644-1110
Practice Address - Fax:503-641-6431
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD67151223P0300X
WAD86161223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134580Medicaid
WA5036165Medicaid
WA0141506OtherLABOR & INDUSTRIES
WA8932837OtherCRIME VICTIMS
OR134580Medicaid