Provider Demographics
NPI:1891777454
Name:PEROUTKA, CARRIE BUERMAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:BUERMAN
Last Name:PEROUTKA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6047 SUMMIT CT
Mailing Address - Street 2:
Mailing Address - City:COTTAGE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55016-4491
Mailing Address - Country:US
Mailing Address - Phone:952-270-7397
Mailing Address - Fax:
Practice Address - Street 1:6105 CAHILL AVE E
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-1525
Practice Address - Country:US
Practice Address - Phone:651-451-9101
Practice Address - Fax:651-451-9887
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN11421122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
116680800Medicare ID - Type Unspecified