Provider Demographics
NPI:1679777098
Name:PERKINS, GREGORY D (DDS)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:D
Last Name:PERKINS
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 1:7430 CREEK RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SANDY
Mailing Address - State:UT
Mailing Address - Zip Code:84093-6160
Mailing Address - Country:US
Mailing Address - Phone:801-255-4870
Mailing Address - Fax:801-255-4882
Practice Address - Street 1:7430 CREEK RD STE 100
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84093-6160
Practice Address - Country:US
Practice Address - Phone:801-255-4870
Practice Address - Fax:801-255-4882
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-11
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT144389-9922122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist