Provider Demographics
NPI:1790855849
Name:PERRY, GREG ALLEN (DDS)
Entity Type:Individual
Prefix:DR
First Name:GREG
Middle Name:ALLEN
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 1:391 WEST STREET
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431
Mailing Address - Country:US
Mailing Address - Phone:603-588-6362
Mailing Address - Fax:603-588-8039
Practice Address - Street 1:391 WEST STREET
Practice Address - Street 2:
Practice Address - City:KEENE
Practice Address - State:NH
Practice Address - Zip Code:03431
Practice Address - Country:US
Practice Address - Phone:603-357-0677
Practice Address - Fax:603-354-7862
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH26241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007934Medicaid