Provider Demographics
NPI:1679792147
Name:PERPICH, PAUL M (DDS)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:M
Last Name:PERPICH
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:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:NISSWA
Mailing Address - State:MN
Mailing Address - Zip Code:56468-0008
Mailing Address - Country:US
Mailing Address - Phone:218-963-4448
Mailing Address - Fax:218-546-5809
Practice Address - Street 1:5461 CITY HALL
Practice Address - Street 2:
Practice Address - City:NISSWA
Practice Address - State:MN
Practice Address - Zip Code:56468
Practice Address - Country:US
Practice Address - Phone:218-963-4448
Practice Address - Fax:218-546-5809
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN94101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN9410OtherSTATE LICENSE
MNIRO83A16PEOtherIRO BCBS
MN845660PEOtherNIS BCBS
MN845660PEOtherNIS BCBS