Provider Demographics
NPI:1245319268
Name:PERELMUTER, MARK J (DMD, M S)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:J
Last Name:PERELMUTER
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Gender:M
Credentials:DMD, M S
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Other - Credentials:
Mailing Address - Street 1:916 DUPONT RD
Mailing Address - Street 2:SECOND FLOOR
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-4662
Mailing Address - Country:US
Mailing Address - Phone:502-897-1112
Mailing Address - Fax:502-897-5279
Practice Address - Street 1:916 DUPONT RD
Practice Address - Street 2:SECOND FLOOR
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4662
Practice Address - Country:US
Practice Address - Phone:502-897-1112
Practice Address - Fax:502-897-5279
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY6106779491223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics