Provider Demographics
NPI:1639192289
Name:PERRY, CALLEY JO (DMD)
Entity Type:Individual
Prefix:DR
First Name:CALLEY
Middle Name:JO
Last Name:PERRY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:DR
Other - First Name:CALLEY
Other - Middle Name:JO
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:490 BEECHWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37814-1218
Mailing Address - Country:US
Mailing Address - Phone:865-332-9011
Mailing Address - Fax:
Practice Address - Street 1:445 S ILLINOIS AVE
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-7510
Practice Address - Country:US
Practice Address - Phone:865-272-2637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN77421223G0001X, 122300000X
KY9158122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN17883Medicaid
TN5441234Medicaid