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General NPI Number Information
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NPI Number | 1356474696
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Entity Type | Individual
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Provider Name | JEFFREY A PERMAN D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 03/14/2007
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Last Update Date | 12/26/2013
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Provider Practice Location Address
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Address Line | 10830 S HALSTED ST
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City | CHICAGO
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State | IL
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Zip | 60628-3126
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Country | US
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Telephone | 773-660-0083
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Fax |
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Provider Business Mailing Address
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Address Line | 2857 W ARTHUR AVE
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City | CHICAGO
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State | IL
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Zip | 60645-5215
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Country | US
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Telephone | 773-660-0083
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 019020638
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License Number State | IL
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