Provider Demographics
NPI:1447453519
Name:ROBERT J. PERREAULT, DDS, PC
Entity type:Organization
Organization Name:ROBERT J. PERREAULT, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:PERREAULT
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:603-362-8410
Mailing Address - Street 1:12 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:ATKINSON
Mailing Address - State:NH
Mailing Address - Zip Code:03811-2514
Mailing Address - Country:US
Mailing Address - Phone:603-362-8410
Mailing Address - Fax:603-362-5493
Practice Address - Street 1:12 MAIN ST
Practice Address - Street 2:
Practice Address - City:ATKINSON
Practice Address - State:NH
Practice Address - Zip Code:03811-2514
Practice Address - Country:US
Practice Address - Phone:603-362-8410
Practice Address - Fax:603-362-5493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH22931223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAZZ7474OtherBLUE CROSS BLUE SHIELD
NH30003666Medicaid