Provider Demographics
NPI:1205035268
Name:PERRY, JOSEPH G (DDS)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:G
Last Name:PERRY
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 114
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13066-0114
Mailing Address - Country:US
Mailing Address - Phone:315-637-9811
Mailing Address - Fax:315-637-2730
Practice Address - Street 1:114 SPRING ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NY
Practice Address - Zip Code:13066-2022
Practice Address - Country:US
Practice Address - Phone:315-637-9811
Practice Address - Fax:315-637-2730
Is Sole Proprietor?:No
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042809-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist