Healthcare Provider Details

I. General information

NPI: 1710976576
Provider Name (Legal Business Name): STEWART IRA PERIM DDS, MS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 S SALISBURY BLVD
SALISBURY MD
21801-7128
US

IV. Provider business mailing address

1505 S SALISBURY BLVD
SALISBURY MD
21801-7128
US

V. Phone/Fax

Practice location:
  • Phone: 410-742-8686
  • Fax: 410-749-6044
Mailing address:
  • Phone: 410-742-8686
  • Fax: 410-749-6044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number7940
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: