Healthcare Provider Details

I. General information

NPI: 1174836100
Provider Name (Legal Business Name): KATE E PERHAM DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 07/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1092 MADISON AVE DENTAL
ALBANY NY
12208-2248
US

IV. Provider business mailing address

1092 MADISON AVE DENTAL
ALBANY NY
12208-2248
US

V. Phone/Fax

Practice location:
  • Phone: 518-525-1757
  • Fax: 518-525-5171
Mailing address:
  • Phone: 518-525-1757
  • Fax: 518-525-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number054923
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: