Provider Demographics
NPI:1790958635
Name:PERRY COUNTY DENTAL GROUP, INC
Entity Type:Organization
Organization Name:PERRY COUNTY DENTAL GROUP, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:GRAY
Authorized Official - Last Name:HAGY
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:740-342-4156
Mailing Address - Street 1:257 E JEFFERSON ST
Mailing Address - Street 2:
Mailing Address - City:NEW LEXINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43764-1060
Mailing Address - Country:US
Mailing Address - Phone:740-342-4156
Mailing Address - Fax:740-342-4156
Practice Address - Street 1:257 E JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:NEW LEXINGTON
Practice Address - State:OH
Practice Address - Zip Code:43764-1060
Practice Address - Country:US
Practice Address - Phone:740-342-4156
Practice Address - Fax:740-342-4156
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty