MEDICARE: DR. ROBERT WILLIAM PERKINS DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	3491	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	5S62509	OTHER		DSHS

General Provider Information

NPI Number	:	1063406353
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT WILLIAM PERKINS DDS

Provider Business Mailing Address
First Line	:	PO BOX 40
Second Line	:
City	:	CLINTON
State	:	WA
Zip	:	98236-0040
Country	:	US
Telephone Number	:	360-341-5606
Fax Number	:	360-341-4797

Provider Business Practice Location Address
First Line	:	6456 CENTRAL AVE
Second Line	:
City	:	CLINTON
State	:	WA
Zip	:	98236-9698
Country	:	US
Telephone Number	:	360-341-5606
Fax Number	:	360-641-4797

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2005
Last Update Date	:	07/08/2007

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