Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0300X | Periodontist | 7786 | GA |
NPI | 1114019395 |
---|---|
Provider Name | Dr. Meyer Ivan Perlstein |
First Address | Atlanta, GA 30328-4274 |
Second Address | Atlanta, GA 30328-4274 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/09/2006 |
Last Update Date | 08/07/2007 |