Provider Demographics
NPI:1942391735
Name:PERKINS, GLENN A (DDS)
Entity Type:Individual
Prefix:DR
First Name:GLENN
Middle Name:A
Last Name:PERKINS
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 1:4749 HIBISCUS AVE
Mailing Address - Street 2:
Mailing Address - City:EDINA
Mailing Address - State:MN
Mailing Address - Zip Code:55435-4001
Mailing Address - Country:US
Mailing Address - Phone:952-927-9715
Mailing Address - Fax:
Practice Address - Street 1:4555 ERIN DR STE 180
Practice Address - Street 2:
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-3334
Practice Address - Country:US
Practice Address - Phone:651-681-9044
Practice Address - Fax:952-681-0599
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10,186122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist