Provider Demographics
NPI:1235478256
Name:PERRY DENTAL INC
Entity Type:Organization
Organization Name:PERRY DENTAL INC
Other - Org Name:ROBERT B PERRY DDS INC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:BLAINE
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:951-688-7150
Mailing Address - Street 1:10333 HOLE AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-1747
Mailing Address - Country:US
Mailing Address - Phone:951-688-7150
Mailing Address - Fax:951-688-0184
Practice Address - Street 1:10333 HOLE AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92505-1747
Practice Address - Country:US
Practice Address - Phone:951-688-7150
Practice Address - Fax:951-688-0184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-12
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20038261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental