Provider Demographics
NPI:1891846754
Name:PERRRY, DAVID W (DMD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:W
Last Name:PERRRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 DAVIS RD
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30907-2407
Mailing Address - Country:US
Mailing Address - Phone:706-863-4212
Mailing Address - Fax:
Practice Address - Street 1:231 DAVIS RD
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30907-2407
Practice Address - Country:US
Practice Address - Phone:706-863-4212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA100531223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
Provider Identifiers
StateIdentifier IDID TypeIssuer
19NCCCCMedicare ID - Type Unspecified
U96370Medicare UPIN