Individual
DR. ETHAN HARRISON PERELLIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DMD
Contact information
Practice address
9451 WESTPORT RD STE 109, LOUISVILLE, KY 40241-2295
(502) 412-5900
Mailing address
9451 WESTPORT RD STE 109, LOUISVILLE, KY 40241-2295
(502) 412-5900
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
10582
KY
Other
Enumeration date
05/19/2021
Last updated
05/19/2021
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