Healthcare Provider Details

I. General information

NPI: 1356722680
Provider Name (Legal Business Name): EVAN PERLER DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 08/13/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1060 HINESBURG RD STE 302
SOUTH BURLINGTON VT
05403-7628
US

IV. Provider business mailing address

1060 HINESBURG RD STE 302
SOUTH BURLINGTON VT
05403-7628
US

V. Phone/Fax

Practice location:
  • Phone: 802-864-3827
  • Fax:
Mailing address:
  • Phone: 802-864-3827
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number058774
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number016.0133904
License Number StateVT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: