Ethan Harrison Perellis, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

10582 Issued in KY

Practice address

9451 Westport Rd Ste 109
Louisville, KY 40241-2295

Phone

(502) 412-5900

NPI assigned

May 19, 2021

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1621382400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621382400000",
    "number": "1629642079",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9451 WESTPORT RD STE 109",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402412295",
            "telephone_number": "502-412-5900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9451 WESTPORT RD STE 109",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402412295",
            "telephone_number": "502-412-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PERELLIS",
        "first_name": "ETHAN",
        "middle_name": "HARRISON",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2021-05-19",
        "last_updated": "2021-05-19",
        "certification_date": "2021-05-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Dentist, General Practice",
            "state": "KY",
            "license": "10582",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Perception Plus Imaging Services LLC
• Mario Manuel Perdomo Santa Cruz, RNFA
• Andrew Perdue
• Victoria Pereira
• David H Perellis, DMD
• Perelmuter & Goldberg Orthodontics
• Mark J Perelmuter, D.M.D., M. S.
• Mikyla Peres, MS, RDN, LD, CN
• Romina Perez Garces, PHARMD
• Diley Perez Garcia, MD

• General Practice Dentistry in Louisville, KY
• Providers in Louisville, KY by specialty
• General Practice Dentistry in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 19, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.