Provider Demographics
NPI:1568503621
Name:PERRY, CLEVELAND STANFORD (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLEVELAND
Middle Name:STANFORD
Last Name:PERRY
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 1:1 BANK ST
Mailing Address - Street 2:# 207
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06901-3006
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 BANK ST
Practice Address - Street 2:# 207
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06901-3006
Practice Address - Country:US
Practice Address - Phone:203-324-3562
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5703122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered122300000XDental ProvidersDentist
Not Answered1223G0001XDental ProvidersDentistGeneral Practice