Healthcare Provider Details

I. General information

NPI: 1417052887
Provider Name (Legal Business Name): PERIHAN A PERCINEL DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S GREEN RIVER RD
EVANSVILLE IN
47715-7334
US

IV. Provider business mailing address

207 S GREEN RIVER RD
EVANSVILLE IN
47715-7334
US

V. Phone/Fax

Practice location:
  • Phone: 812-476-3131
  • Fax: 812-476-6621
Mailing address:
  • Phone: 812-476-3131
  • Fax: 812-476-6621

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number8339
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12010957A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: