Provider Demographics
NPI:1366403008
Name:PERNA, SALVATORE F (DDS)
Entity type:Individual
Prefix:DR
First Name:SALVATORE
Middle Name:F
Last Name:PERNA
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 1:16605 E PALISADES BLVD
Mailing Address - Street 2:#112
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3716
Mailing Address - Country:US
Mailing Address - Phone:480-837-2000
Mailing Address - Fax:480-837-2078
Practice Address - Street 1:16605 E PALISADES BLVD
Practice Address - Street 2:#112
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3716
Practice Address - Country:US
Practice Address - Phone:480-837-2000
Practice Address - Fax:480-837-2078
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ64161223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice