Healthcare Provider Details

I. General information

NPI: 1457448979
Provider Name (Legal Business Name): KAREN D PERRIN RDH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 NAVARRA WAY SE
ALBUQUERQUE NM
87123-4521
US

IV. Provider business mailing address

714 NAVARRA WAY SE
ALBUQUERQUE NM
87123-4521
US

V. Phone/Fax

Practice location:
  • Phone: 505-288-1998
  • Fax:
Mailing address:
  • Phone: 505-288-1998
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code124Q00000X
TaxonomyDental Hygienist
License NumberNM1687
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: