Provider Demographics
NPI:1972514156
Name:PERRY, JACQUELINE (RDH)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:PERRY
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98421-1108
Mailing Address - Country:US
Mailing Address - Phone:253-597-4550
Mailing Address - Fax:256-597-4556
Practice Address - Street 1:101 E 26TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98421-1108
Practice Address - Country:US
Practice Address - Phone:253-597-4550
Practice Address - Fax:256-597-4556
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADH00005685124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist