Provider Demographics
NPI:1770652950
Name:PERLMUTTER, CARL JONAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:JONAS
Last Name:PERLMUTTER
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:40 SEAVER ST # 7
Mailing Address - Street 2:
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481
Mailing Address - Country:US
Mailing Address - Phone:781-235-3104
Mailing Address - Fax:617-332-5108
Practice Address - Street 1:4 LYMAN STREET
Practice Address - Street 2:
Practice Address - City:NEWTON CENTRE
Practice Address - State:MA
Practice Address - Zip Code:02459
Practice Address - Country:US
Practice Address - Phone:617-332-2434
Practice Address - Fax:617-332-5108
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA99961223X0400X
MADN99961223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics