Provider Demographics
NPI:1912947094
Name:SHOWALTER, PERRY L (DDS)
Entity type:Individual
Prefix:DR
First Name:PERRY
Middle Name:L
Last Name:SHOWALTER
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 1:4326 GEORGE WASHINGTON MEMORIAL HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN
Mailing Address - State:VA
Mailing Address - Zip Code:23692
Mailing Address - Country:US
Mailing Address - Phone:757-898-6788
Mailing Address - Fax:757-898-1042
Practice Address - Street 1:4326 GEORGE WASHINGTON MEMORIAL HIGHWAY
Practice Address - Street 2:
Practice Address - City:YORKTOWN
Practice Address - State:VA
Practice Address - Zip Code:23692
Practice Address - Country:US
Practice Address - Phone:757-898-6788
Practice Address - Fax:757-898-1042
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA65671223G0001X
VA0401006567122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice