Provider Demographics
NPI:1598978603
Name:PERROTTA, DENISE A (DMD)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:A
Last Name:PERROTTA
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1409 PLAZA WEST ROAD
Mailing Address - Street 2:SUITE H
Mailing Address - City:WINSTON-SALEM
Mailing Address - State:NC
Mailing Address - Zip Code:27103
Mailing Address - Country:US
Mailing Address - Phone:336-760-9258
Mailing Address - Fax:336-659-9258
Practice Address - Street 1:1409 PLAZA WEST ROAD
Practice Address - Street 2:SUITE H
Practice Address - City:WINSTON-SALEM
Practice Address - State:NC
Practice Address - Zip Code:27103
Practice Address - Country:US
Practice Address - Phone:336-760-9258
Practice Address - Fax:336-659-9258
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2010-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC89051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice