Provider Demographics
NPI:1548344476
Name:PERLOT, ROBERT LEE JR (DMD, MS)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEE
Last Name:PERLOT
Suffix:JR
Gender:M
Credentials:DMD, MS
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Mailing Address - Street 1:1415 HARRISON AVE NW
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-5332
Mailing Address - Country:US
Mailing Address - Phone:360-786-1600
Mailing Address - Fax:360-705-2116
Practice Address - Street 1:1415 HARRISON AVE. N.W.
Practice Address - Street 2:SUITE 202
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502
Practice Address - Country:US
Practice Address - Phone:360-786-1600
Practice Address - Fax:360-705-2116
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2013-08-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PADS030408L1223X0400X
WADE601150811223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE60115081OtherLICENSE