Provider Demographics
NPI:1639271760
Name:PERENACK, JON D (MD DDS)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:D
Last Name:PERENACK
Suffix:
Gender:M
Credentials:MD DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3800 HOUMA BLVD
Mailing Address - Street 2:STE 305
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-4182
Mailing Address - Country:US
Mailing Address - Phone:504-889-9893
Mailing Address - Fax:504-889-9895
Practice Address - Street 1:3800 HOUMA BLVD
Practice Address - Street 2:STE 305
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-4182
Practice Address - Country:US
Practice Address - Phone:504-889-9893
Practice Address - Fax:504-889-9895
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LAP881223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA4F1376781Medicare PIN