Healthcare Provider Details

I. General information

NPI: 1740535566
Provider Name (Legal Business Name): SETH LOUNSBURY PERRINS D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 07/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CAMP FOSTER POST OFFICE BLDG. 5717
FPO AP
96379
US

IV. Provider business mailing address

EVANS DENTAL CLINIC CAMP FOSTER BLDG. 5717 ON TARAWA ST.
FPO AP
47211
US

V. Phone/Fax

Practice location:
  • Phone: 98-645-7381
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number60294726
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: