Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 0401411570 | VA |
NPI | 1003968637 |
---|---|
Provider Name | Seth Tyler Perkinson |
First Address | Midlothian, VA 23113 |
Second Address | Midlothian, VA 23113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2007 |
Last Update Date | 08/07/2007 |