Provider Demographics
NPI:1356492276
Name:PERRY, CARMELLA B (DDS)
Entity Type:Individual
Prefix:
First Name:CARMELLA
Middle Name:B
Last Name:PERRY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 FLOSSMOOR RD
Mailing Address - Street 2:
Mailing Address - City:FLOSSMOOR
Mailing Address - State:IL
Mailing Address - Zip Code:60422-1141
Mailing Address - Country:US
Mailing Address - Phone:708-799-9755
Mailing Address - Fax:707-799-8377
Practice Address - Street 1:2711 FLOSSMOOR RD
Practice Address - Street 2:
Practice Address - City:FLOSSMOOR
Practice Address - State:IL
Practice Address - Zip Code:60422-1141
Practice Address - Country:US
Practice Address - Phone:708-799-9755
Practice Address - Fax:707-799-8377
Is Sole Proprietor?:No
Enumeration Date:2007-01-16
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190198771223P0221X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry