Provider Demographics
NPI:1720172596
Name:PERKINS DENTAL ASSOCIATES
Entity Type:Organization
Organization Name:PERKINS DENTAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GRETCHEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:724-935-4210
Mailing Address - Street 1:101 BRADFORD RD
Mailing Address - Street 2:SUITE 270
Mailing Address - City:WEXFORD
Mailing Address - State:PA
Mailing Address - Zip Code:15090-6909
Mailing Address - Country:US
Mailing Address - Phone:724-935-4210
Mailing Address - Fax:724-935-8853
Practice Address - Street 1:101 BRADFORD RD
Practice Address - Street 2:SUITE 270
Practice Address - City:WEXFORD
Practice Address - State:PA
Practice Address - Zip Code:15090-6909
Practice Address - Country:US
Practice Address - Phone:724-935-4210
Practice Address - Fax:724-935-8853
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS025730L1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty