MEDICARE: EDWARD H PERKL 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	1223G0001X	General Practice Dentistry	DE00004970	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	113457	OTHER		UNITED CONCORDIA INS

General Provider Information

NPI Number	:	1699727792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EDWARD H PERKL DDS

Provider Business Mailing Address
First Line	:	19718 68TH AVE W
Second Line	:	STE F
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-5965
Country	:	US
Telephone Number	:	425-778-2126
Fax Number	:	425-775-2329

Provider Business Practice Location Address
First Line	:	19718 68TH AVE W
Second Line	:	STE F
City	:	LYNNWOOD
State	:	WA
Zip	:	98036-5965
Country	:	US
Telephone Number	:	425-778-2126
Fax Number	:	425-775-2329

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

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/08/2007

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1881860864 — EDWARD H. PERKL, DDS, PS
Practice Location Address:

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LYNNWOOD, WA
98036-5965

Practice Phone: 425-778-2126
Practice Fax: 425-775-2329

Directions to “ EDWARD H PERKL DDS” Practice Location

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