Provider Demographics
NPI:1508501545
Name:PERKINS, PATRICK T
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:T
Last Name:PERKINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2278 SPRING HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:FRANCIS
Mailing Address - State:UT
Mailing Address - Zip Code:84036-9610
Mailing Address - Country:US
Mailing Address - Phone:385-290-9156
Mailing Address - Fax:
Practice Address - Street 1:1662 S 2000 W STE A1
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-7145
Practice Address - Country:US
Practice Address - Phone:585-275-5051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13346702-99221223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice