Provider Demographics
NPI:1295889459
Name:PERKO, MARK W (DDS)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:W
Last Name:PERKO
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 1:2045 FOREST EDGE DR
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44223-3365
Mailing Address - Country:US
Mailing Address - Phone:330-923-3322
Mailing Address - Fax:
Practice Address - Street 1:673 E WILBETH RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44306-3455
Practice Address - Country:US
Practice Address - Phone:330-724-2551
Practice Address - Fax:330-724-7726
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH172771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0553986Medicaid