Provider Demographics
NPI:1558819185
Name:PERRY, ROBERT SHAUN JR (DDS, MPH)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SHAUN
Last Name:PERRY
Suffix:JR
Gender:M
Credentials:DDS, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11136 YARDLEY PL
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3202
Mailing Address - Country:US
Mailing Address - Phone:951-905-8737
Mailing Address - Fax:
Practice Address - Street 1:11136 YARDLEY PL
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3202
Practice Address - Country:US
Practice Address - Phone:951-905-8737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-12
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA100586122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist