Provider Demographics
NPI:1306207113
Name:PAUL PERPICH, DDS
Entity Type:Organization
Organization Name:PAUL PERPICH, DDS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:M
Authorized Official - Last Name:PERPICH
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:218-546-5809
Mailing Address - Street 1:PO BOX 464
Mailing Address - Street 2:338 CURTIS AVE.
Mailing Address - City:IRONTON
Mailing Address - State:MN
Mailing Address - Zip Code:56455
Mailing Address - Country:US
Mailing Address - Phone:218-546-5809
Mailing Address - Fax:218-772-0239
Practice Address - Street 1:5461 CITY HALL ST
Practice Address - Street 2:
Practice Address - City:NISSWA
Practice Address - State:MN
Practice Address - Zip Code:56468-2478
Practice Address - Country:US
Practice Address - Phone:218-546-5809
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN9410305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization