Provider Demographics
NPI:1659332252
Name:PERRY, ALAN CHARLES (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:CHARLES
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 1:415 1ST AVE E
Mailing Address - Street 2:
Mailing Address - City:SHAKOPEE
Mailing Address - State:MN
Mailing Address - Zip Code:55379-1439
Mailing Address - Country:US
Mailing Address - Phone:952-445-5510
Mailing Address - Fax:952-445-8427
Practice Address - Street 1:415 1ST AVE E
Practice Address - Street 2:
Practice Address - City:SHAKOPEE
Practice Address - State:MN
Practice Address - Zip Code:55379-1439
Practice Address - Country:US
Practice Address - Phone:952-445-5510
Practice Address - Fax:952-445-8427
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN89751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice