Provider Demographics
NPI:1013120906
Name:PERL, MICHAEL MARK (DDS)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:MARK
Last Name:PERL
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 1:71 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1147
Mailing Address - Country:US
Mailing Address - Phone:860-767-1311
Mailing Address - Fax:860-767-2112
Practice Address - Street 1:61 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2486
Practice Address - Country:US
Practice Address - Phone:860-236-2566
Practice Address - Fax:860-236-2282
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT37651223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics