Provider Demographics
NPI:1700260205
Name:PERMAN, ZACHARY ISAIAH (DMD)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:ISAIAH
Last Name:PERMAN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 106
Mailing Address - Street 2:2507 3RD AVE
Mailing Address - City:SELBY
Mailing Address - State:SD
Mailing Address - Zip Code:57472-0106
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:611 2ND AVENUE EAST
Practice Address - Street 2:
Practice Address - City:MCLAUGHLIN
Practice Address - State:SD
Practice Address - Zip Code:57642
Practice Address - Country:US
Practice Address - Phone:605-823-2358
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD1093122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist