Provider Demographics
NPI:1679658025
Name:BOB S. PERKINS D.D.S.
Entity Type:Organization
Organization Name:BOB S. PERKINS D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LAURIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:DICHTEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-419-6900
Mailing Address - Street 1:24955 PACIFIC COAST HIGHWAY
Mailing Address - Street 2:SUITE C100
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265
Mailing Address - Country:US
Mailing Address - Phone:805-955-0181
Mailing Address - Fax:805-955-0185
Practice Address - Street 1:24955 PACIFIC COAST HIGHWAY
Practice Address - Street 2:SUITE C100
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265
Practice Address - Country:US
Practice Address - Phone:310-419-6900
Practice Address - Fax:310-456-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-26
Last Update Date:2014-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA38116122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty