=====================================================
General NPI Number Information
=====================================================
NPI Number | 1487904058
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | EDWARD PERKINS D.D.S. PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/11/2012
-----------------------------------------------------
Last Update Date | 10/25/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5314 E 115 ST
-----------------------------------------------------
City | KANSAS CTIY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-761-2878
-----------------------------------------------------
Fax | 816-761-0614
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5314 E 115 ST
-----------------------------------------------------
City | KANSAS CTIY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64137
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 816-761-2878
-----------------------------------------------------
Fax | 816-761-0614
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | EDWARD JOHN PERKINS JR.
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 816-761-2878
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 015596
-----------------------------------------------------
License Number State | MO
-----------------------------------------------------