Provider Demographics
NPI:1558493072
Name:PERCY, KENT HEREFORD (DDS)
Entity Type:Individual
Prefix:DR
First Name:KENT
Middle Name:HEREFORD
Last Name:PERCY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 WHITLOCK AVE NW
Mailing Address - Street 2:SUITE # 380
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30064-5455
Mailing Address - Country:US
Mailing Address - Phone:770-425-4748
Mailing Address - Fax:770-425-4749
Practice Address - Street 1:1000 WHITLOCK AVE NW
Practice Address - Street 2:SUITE 380
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30064-5455
Practice Address - Country:US
Practice Address - Phone:770-425-4748
Practice Address - Fax:770-425-4749
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-10
Last Update Date:2008-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA109191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice