Provider Demographics
NPI:1710976576
Name:PERIM, STEWART IRA (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:STEWART
Middle Name:IRA
Last Name:PERIM
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1505 S SALISBURY BLVD
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-7128
Mailing Address - Country:US
Mailing Address - Phone:410-742-8686
Mailing Address - Fax:410-749-6044
Practice Address - Street 1:1505 S SALISBURY BLVD
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-7128
Practice Address - Country:US
Practice Address - Phone:410-742-8686
Practice Address - Fax:410-749-6044
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-14
Last Update Date:2015-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD79401223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics