Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 3306-04 | MS |
Y | 1223P0221X | Pediatric Dentist | PEDO-397-06 | MS |
NPI | 1033152020 |
---|---|
Provider Name | Dr. Charles Hayden Perkins |
First Address | Oxford, MS 38655 |
Second Address | Oxford, MS 38655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 14/06/2006 |
Last Update Date | 31/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
07409833 | (05) | MS |
09870248 | (05) | MS |