Provider Demographics
NPI:1437749694
Name:PERRY DENTAL
Entity Type:Organization
Organization Name:PERRY DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:435-723-4300
Mailing Address - Street 1:2535 S HIGHWAY 89 STE 1
Mailing Address - Street 2:
Mailing Address - City:PERRY
Mailing Address - State:UT
Mailing Address - Zip Code:84302-6728
Mailing Address - Country:US
Mailing Address - Phone:435-723-4300
Mailing Address - Fax:
Practice Address - Street 1:2535 S HIGHWAY 89 STE 1
Practice Address - Street 2:
Practice Address - City:PERRY
Practice Address - State:UT
Practice Address - Zip Code:84302-6728
Practice Address - Country:US
Practice Address - Phone:435-723-4300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental