Provider Demographics
NPI:1346759313
Name:PERRY, JUDY (RDH)
Entity Type:Individual
Prefix:
First Name:JUDY
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2741 12 MILE RD
Mailing Address - Street 2:
Mailing Address - City:BERKLEY
Mailing Address - State:MI
Mailing Address - Zip Code:48072-1629
Mailing Address - Country:US
Mailing Address - Phone:248-439-0088
Mailing Address - Fax:
Practice Address - Street 1:2741 12 MILE RD
Practice Address - Street 2:
Practice Address - City:BERKLEY
Practice Address - State:MI
Practice Address - Zip Code:48072-1629
Practice Address - Country:US
Practice Address - Phone:248-439-0088
Practice Address - Fax:248-439-2900
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2902018233124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1780096792Medicaid