Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | D009112 | OH |
NPI | 1023452679 |
---|---|
Provider Name | Dr. Jaron Beau Perkins |
First Address | Prescott, AZ 86305-2826 |
Second Address | Prescott, AZ 86305-2826 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2013 |
Last Update Date | 16/07/2015 |