Provider Demographics
NPI:1013189034
Name:PERRY FAMILY DENTISTRY, LLC
Entity Type:Organization
Organization Name:PERRY FAMILY DENTISTRY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ALDRICH
Authorized Official - Middle Name:TYRONE
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:615-896-3360
Mailing Address - Street 1:PO BOX 861
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37133-0861
Mailing Address - Country:US
Mailing Address - Phone:615-896-3360
Mailing Address - Fax:615-896-1055
Practice Address - Street 1:1121 GREENLAND DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2751
Practice Address - Country:US
Practice Address - Phone:615-896-3360
Practice Address - Fax:616-589-6105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000046581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3225329Medicaid