Healthcare Provider Details

I. General information

NPI: 1265192454
Provider Name (Legal Business Name): ROBERT D PERROTT DMD LIMITED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2021
Last Update Date: 12/29/2021
Certification Date: 12/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BRISTLEWOOD DR
BOARDMAN OH
44512-5111
US

IV. Provider business mailing address

7200 BRISTLEWOOD DR
BOARDMAN OH
44512-5111
US

V. Phone/Fax

Practice location:
  • Phone: 330-726-0090
  • Fax: 330-726-1002
Mailing address:
  • Phone: 330-726-0090
  • Fax: 330-726-1002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ROBERT D PERROTT
Title or Position: OWNER
Credential: DMD
Phone: 330-726-0090