Provider Demographics
NPI:1306159371
Name:PERMANN, ERIK W (DDS)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:W
Last Name:PERMANN
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 1:285 CANYON CREST DR.
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301
Mailing Address - Country:US
Mailing Address - Phone:208-733-9999
Mailing Address - Fax:208-733-9699
Practice Address - Street 1:125 W PARK AVE
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:TX
Practice Address - Zip Code:79045-4201
Practice Address - Country:US
Practice Address - Phone:806-364-7688
Practice Address - Fax:806-364-7694
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX258011223G0001X
IDD-4455122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice