Provider Demographics
NPI:1235382805
Name:DR. FRANK C. PERRY D.D.S.
Entity Type:Organization
Organization Name:DR. FRANK C. PERRY D.D.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:C
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:631-654-0707
Mailing Address - Street 1:74 SOUTHAVEN AVE.
Mailing Address - Street 2:STE A
Mailing Address - City:MEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:11763
Mailing Address - Country:US
Mailing Address - Phone:631-654-0707
Mailing Address - Fax:631-207-8466
Practice Address - Street 1:74 SOUTHAVEN AVE.
Practice Address - Street 2:STE A
Practice Address - City:MEDFORD
Practice Address - State:NY
Practice Address - Zip Code:11763
Practice Address - Country:US
Practice Address - Phone:631-654-0707
Practice Address - Fax:631-207-8466
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. FRANK C. PERRY D.D.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY451101223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty