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General NPI Number Information
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NPI Number | 1023452679
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Entity Type | Individual
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Provider Name | JARON BEAU PERKINS D.M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/25/2013
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Last Update Date | 07/16/2015
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Provider Practice Location Address
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Address Line | 1306 W GURLEY ST
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City | PRESCOTT
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State | AZ
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Zip | 86305-2826
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Country | US
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Telephone | 928-776-1700
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Fax |
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Provider Business Mailing Address
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Address Line | 1306 W GURLEY ST
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City | PRESCOTT
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State | AZ
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Zip | 86305-2826
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Country | US
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Telephone | 602-692-3431
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223P0221X
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Taxonomy Name | Pediatric Dentistry
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License Number | D009112
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License Number State | OH
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