Provider Demographics
NPI:1376971895
Name:PERKINS DENTAL, PLLC
Entity Type:Organization
Organization Name:PERKINS DENTAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:VAUGHN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:III
Authorized Official - Credentials:DMD
Authorized Official - Phone:623-561-8700
Mailing Address - Street 1:10200 W HAPPY VALLEY RD
Mailing Address - Street 2:SUITE #130
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-2878
Mailing Address - Country:US
Mailing Address - Phone:623-561-8700
Mailing Address - Fax:623-566-5906
Practice Address - Street 1:10200 W HAPPY VALLEY RD
Practice Address - Street 2:SUITE #130
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-2878
Practice Address - Country:US
Practice Address - Phone:623-561-8700
Practice Address - Fax:623-566-5906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-18
Last Update Date:2013-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty