Provider Demographics
NPI:1912019126
Name:PERRY, GLORIA FIELDS (DMD)
Entity Type:Individual
Prefix:DR
First Name:GLORIA
Middle Name:FIELDS
Last Name:PERRY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:MS
Other - First Name:GLORIA
Other - Middle Name:F
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:33 LITTLE RIVER LN
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-632-1788
Mailing Address - Fax:
Practice Address - Street 1:75 BERLIN RD
Practice Address - Street 2:SUITE 106
Practice Address - City:CROMWELL
Practice Address - State:CT
Practice Address - Zip Code:06416
Practice Address - Country:US
Practice Address - Phone:860-635-3209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0063551223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice