Provider Demographics
NPI:1922033190
Name:PERRY, PAUL C (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:C
Last Name:PERRY
Suffix:
Gender:M
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3109 MAPLEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SULPHUR
Mailing Address - State:LA
Mailing Address - Zip Code:70663-6201
Mailing Address - Country:US
Mailing Address - Phone:337-625-5330
Mailing Address - Fax:337-625-5335
Practice Address - Street 1:3109 MAPLEWOOD DR
Practice Address - Street 2:
Practice Address - City:SULPHUR
Practice Address - State:LA
Practice Address - Zip Code:70663-6201
Practice Address - Country:US
Practice Address - Phone:337-625-5330
Practice Address - Fax:337-625-5335
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA43721223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics