Provider Demographics
NPI:1902595317
Name:PERLL, JAMES DAVID
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DAVID
Last Name:PERLL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11201 OUTLOOK ST APT 3253
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66211-1975
Mailing Address - Country:US
Mailing Address - Phone:573-721-1181
Mailing Address - Fax:
Practice Address - Street 1:16103 W 135TH ST
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1516
Practice Address - Country:US
Practice Address - Phone:913-829-9222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-02
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS621141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice