Provider Demographics
NPI:1407989551
Name:PERRY, MADELINNE KAY (DDS)
Entity Type:Individual
Prefix:DR
First Name:MADELINNE
Middle Name:KAY
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 1:2010 THAYER CIR
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27407-7736
Mailing Address - Country:US
Mailing Address - Phone:336-299-6676
Mailing Address - Fax:336-856-9018
Practice Address - Street 1:5200 MACKAY RD
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:NC
Practice Address - Zip Code:27282-9762
Practice Address - Country:US
Practice Address - Phone:336-856-9001
Practice Address - Fax:336-856-9018
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2024-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC45241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA033079OtherBCBS OF VA
NC96832OtherBCBS OF NC