Provider Demographics
NPI:1700910635
Name:PERRY, ALDRICH TYRONE (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALDRICH
Middle Name:TYRONE
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:PO BOX 861
Mailing Address - Street 2:
Mailing Address - City:MURFREESBORO
Mailing Address - State:TN
Mailing Address - Zip Code:37133-0861
Mailing Address - Country:US
Mailing Address - Phone:615-896-3360
Mailing Address - Fax:615-896-1055
Practice Address - Street 1:1121 GREENLAND DR
Practice Address - Street 2:
Practice Address - City:MURFREESBORO
Practice Address - State:TN
Practice Address - Zip Code:37130-2751
Practice Address - Country:US
Practice Address - Phone:615-896-3360
Practice Address - Fax:615-896-1055
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDS00000046581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3225329Medicaid