Provider Demographics
NPI:1770577140
Name:PERRY, GEORGE LAWRENCE (DDS)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:LAWRENCE
Last Name:PERRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:G.
Other - Middle Name:LAWRENCE
Other - Last Name:PERRY I
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:10700 N LA RESERVE DR
Mailing Address - Street 2:4206
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-9199
Mailing Address - Country:US
Mailing Address - Phone:520-219-7985
Mailing Address - Fax:
Practice Address - Street 1:10700 N LA RESERVE DR
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-9078
Practice Address - Country:US
Practice Address - Phone:520-219-7985
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY050242122300000X
AZD6086122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist