Provider Demographics
NPI:1548484074
Name:PERJESSY, GABRIEL (DDS)
Entity type:Individual
Prefix:DR
First Name:GABRIEL
Middle Name:
Last Name:PERJESSY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 BURNS WAY
Mailing Address - Street 2:# 2
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901
Mailing Address - Country:US
Mailing Address - Phone:406-752-6776
Mailing Address - Fax:406-752-6771
Practice Address - Street 1:1250 BURNS WAY
Practice Address - Street 2:# 2
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901
Practice Address - Country:US
Practice Address - Phone:406-752-6776
Practice Address - Fax:406-752-6771
Is Sole Proprietor?:No
Enumeration Date:2007-04-13
Last Update Date:2008-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1305122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
13054OtherBCBS
MT128063Medicaid
MT5512325 CHIPSMedicaid