Provider Demographics
NPI:1013916980
Name:PERKINS, JEFF RANDALL (DDS)
Entity Type:Individual
Prefix:DR
First Name:JEFF
Middle Name:RANDALL
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 1:231 AUBURN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-6233
Mailing Address - Country:US
Mailing Address - Phone:831-419-6363
Mailing Address - Fax:
Practice Address - Street 1:9061 SOQUEL DR
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4001
Practice Address - Country:US
Practice Address - Phone:831-688-3633
Practice Address - Fax:831-688-3702
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-21
Last Update Date:2007-07-08
Deactivation Date:2006-03-20
Deactivation Code:
Reactivation Date:2006-04-06
Provider Licenses
StateLicense IDTaxonomies
CA382161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice