Provider Demographics
NPI:1265748941
Name:PERRY, KEVIN SCOTT (DDS)
Entity type:Individual
Prefix:MR
First Name:KEVIN
Middle Name:SCOTT
Last Name:PERRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6753 N WILLOW AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5900
Mailing Address - Country:US
Mailing Address - Phone:559-424-1088
Mailing Address - Fax:559-314-6753
Practice Address - Street 1:6753 N WILLOW AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5900
Practice Address - Country:US
Practice Address - Phone:559-424-1088
Practice Address - Fax:559-314-6753
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA595661223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice