Provider Demographics
NPI:1407385206
Name:PERRY, STEVEN DAVID (DMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:DAVID
Last Name:PERRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:807 E KARSCH BLVD
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:MO
Mailing Address - Zip Code:63640-3025
Mailing Address - Country:US
Mailing Address - Phone:573-756-5760
Mailing Address - Fax:573-756-8040
Practice Address - Street 1:807 E KARSCH BLVD
Practice Address - Street 2:
Practice Address - City:FARMINGTON
Practice Address - State:MO
Practice Address - Zip Code:63640-3025
Practice Address - Country:US
Practice Address - Phone:573-756-5760
Practice Address - Fax:573-756-8040
Is Sole Proprietor?:No
Enumeration Date:2017-06-06
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORD10642122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist