Provider Demographics
NPI:1881860864
Name:EDWARD H. PERKL, DDS, PS
Entity Type:Organization
Organization Name:EDWARD H. PERKL, DDS, PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:H
Authorized Official - Last Name:PERKL
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:425-778-2126
Mailing Address - Street 1:19718 68TH AVE W
Mailing Address - Street 2:SUITE F
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98036-5965
Mailing Address - Country:US
Mailing Address - Phone:425-778-2126
Mailing Address - Fax:425-775-2329
Practice Address - Street 1:19718 68TH AVE W
Practice Address - Street 2:SUITE F
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98036-5965
Practice Address - Country:US
Practice Address - Phone:425-778-2126
Practice Address - Fax:425-775-2329
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-30
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE000049701223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty