Provider Demographics
NPI:1417165713
Name:PERLITA M. DUTTON, DDS, PA
Entity Type:Organization
Organization Name:PERLITA M. DUTTON, DDS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PERLITA
Authorized Official - Middle Name:M
Authorized Official - Last Name:DUTTON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:620-626-4700
Mailing Address - Street 1:23 PROFESSIONAL DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:LIBERAL
Mailing Address - State:KS
Mailing Address - Zip Code:67901-1803
Mailing Address - Country:US
Mailing Address - Phone:620-626-4700
Mailing Address - Fax:620-624-2474
Practice Address - Street 1:23 PROFESSIONAL DR
Practice Address - Street 2:SUITE A
Practice Address - City:LIBERAL
Practice Address - State:KS
Practice Address - Zip Code:67901-1803
Practice Address - Country:US
Practice Address - Phone:620-626-4700
Practice Address - Fax:620-624-2474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS58951223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS420776OtherBCBS OF KS