Provider Demographics
NPI:1750091948
Name:ROBERT PERRY DBA HILDALE DENTAL
Entity type:Organization
Organization Name:ROBERT PERRY DBA HILDALE DENTAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:541-993-9268
Mailing Address - Street 1:1080 W UTAH AVE # 841632
Mailing Address - Street 2:
Mailing Address - City:HILDALE
Mailing Address - State:UT
Mailing Address - Zip Code:84784-7710
Mailing Address - Country:US
Mailing Address - Phone:435-218-7172
Mailing Address - Fax:435-200-9416
Practice Address - Street 1:1080 W UTAH AVE # 841632
Practice Address - Street 2:
Practice Address - City:HILDALE
Practice Address - State:UT
Practice Address - Zip Code:84784-7710
Practice Address - Country:US
Practice Address - Phone:435-218-7172
Practice Address - Fax:435-200-9416
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-29
Last Update Date:2022-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1092154Medicaid