Provider Demographics
NPI:1972534568
Name:PERLMAN, MARK STEWART (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:STEWART
Last Name:PERLMAN
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 1:7124 BROOKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:BROOKFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44403
Mailing Address - Country:US
Mailing Address - Phone:330-448-2571
Mailing Address - Fax:330-448-2680
Practice Address - Street 1:7124 BROOKWOOD DR
Practice Address - Street 2:
Practice Address - City:BROOKFIELD
Practice Address - State:OH
Practice Address - Zip Code:44403
Practice Address - Country:US
Practice Address - Phone:330-448-2571
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH16515122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0483132Medicaid