Provider Demographics
NPI:1194106013
Name:PERKINS DENTAL GROUP
Entity type:Organization
Organization Name:PERKINS DENTAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSHUA
Authorized Official - Middle Name:V
Authorized Official - Last Name:BRASHER
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:405-474-6362
Mailing Address - Street 1:1333 E DANFORTH RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-3201
Mailing Address - Country:US
Mailing Address - Phone:405-474-6362
Mailing Address - Fax:405-421-0744
Practice Address - Street 1:3901 E COVELL RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-6909
Practice Address - Country:US
Practice Address - Phone:405-474-6362
Practice Address - Fax:405-421-0744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-16
Last Update Date:2015-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6256122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty