Provider Demographics
NPI:1295751659
Name:WAINMAN, PERRY ALLEN (DDS)
Entity type:Individual
Prefix:
First Name:PERRY
Middle Name:ALLEN
Last Name:WAINMAN
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:PO BOX 143
Mailing Address - Street 2:
Mailing Address - City:GREENCASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:46135-0143
Mailing Address - Country:US
Mailing Address - Phone:765-653-8615
Mailing Address - Fax:765-653-5227
Practice Address - Street 1:18 E WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:GREENCASTLE
Practice Address - State:IN
Practice Address - Zip Code:46135
Practice Address - Country:US
Practice Address - Phone:765-653-8615
Practice Address - Fax:765-653-5227
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN12006994122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
INAW5121241OtherDEA NUMBER