MEDICARE: DR. GARY DAVID PERLMAN D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223P0300X	Periodontics	9695	FL

General Provider Information

NPI Number	:	1891790432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY DAVID PERLMAN D.D.S.

Provider Business Mailing Address
First Line	:	3990 SAN JOSE PARK DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4613
Country	:	US
Telephone Number	:	904-731-1324
Fax Number	:	904-731-1326

Provider Business Practice Location Address
First Line	:	3990 SAN JOSE PARK DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32217-4613
Country	:	US
Telephone Number	:	904-731-1324
Fax Number	:	904-731-1326

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2005
Last Update Date	:	07/08/2007

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