Basic Information
| Provider Information | |||||||||
| NPI: | 1275648859 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PERRY A WAINMAN, DDS PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 143 | ||||||||
| Address2: | |||||||||
| City: | GREENCASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 461350143 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656538615 | ||||||||
| FaxNumber: | 7656535227 | ||||||||
| Practice Location | |||||||||
| Address1: | 18 E WASHINGTON ST | ||||||||
| Address2: | |||||||||
| City: | GREENCASTLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46135 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656538615 | ||||||||
| FaxNumber: | 7656535227 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/21/2006 | ||||||||
| LastUpdateDate: | 12/18/2007 | ||||||||
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| AuthorizedOfficialLastName: | WAINMAN | ||||||||
| AuthorizedOfficialFirstName: | PERRY | ||||||||
| AuthorizedOfficialMiddleName: | ALLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | DENTIST | ||||||||
| AuthorizedOfficialTelephone: | 7656538615 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 122300000X | IN | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist |
No ID Information.