Provider Demographics
NPI:1881854628
Name:BLANK, PERRIN (DDS)
Entity Type:Individual
Prefix:DR
First Name:PERRIN
Middle Name:
Last Name:BLANK
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 VILLAGE BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-1950
Mailing Address - Country:US
Mailing Address - Phone:561-833-2364
Mailing Address - Fax:561-833-7790
Practice Address - Street 1:603 VILLAGE BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-1950
Practice Address - Country:US
Practice Address - Phone:561-833-2364
Practice Address - Fax:561-833-7790
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9050122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist