Provider Demographics
NPI:1891821252
Name:PERRY, TARA F (DMD)
Entity Type:Individual
Prefix:DR
First Name:TARA
Middle Name:F
Last Name:PERRY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD
Mailing Address - Street 2:SUITE 4103
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4539
Mailing Address - Country:US
Mailing Address - Phone:770-831-5568
Mailing Address - Fax:770-831-5527
Practice Address - Street 1:1300 PEACHTREE INDUSTRIAL BLVD
Practice Address - Street 2:SUITE 4103
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4539
Practice Address - Country:US
Practice Address - Phone:770-831-5568
Practice Address - Fax:770-831-5527
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0125481223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice