MEDICARE: DR. KENNETH EUGENE PERINO D.D.S.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	HD104742	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871674069
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KENNETH EUGENE PERINO D.D.S.

Provider Business Mailing Address
First Line	:	2532 PATTERSON ROAD
Second Line	:	SUITE 10
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1098
Country	:	US
Telephone Number	:	970-241-2820
Fax Number	:	970-248-9553

Provider Business Practice Location Address
First Line	:	2532 PATTERSON ROAD
Second Line	:	SUITE 10
City	:	GRAND JUNCTION
State	:	CO
Zip	:	81505-1098
Country	:	US
Telephone Number	:	970-241-2820
Fax Number	:	970-248-9553

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

Provider Enumeration Date	:	10/17/2006
Last Update Date	:	03/02/2010

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Directions to “ DR. KENNETH EUGENE PERINO D.D.S.” Practice Location

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