Provider Demographics
NPI:1780088575
Name:NANCY M PERRON, DMD, PLLC
Entity type:Organization
Organization Name:NANCY M PERRON, DMD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:MARRA
Authorized Official - Last Name:PERRON
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:941-749-7638
Mailing Address - Street 1:4012 9TH AVE W
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34205-1706
Mailing Address - Country:US
Mailing Address - Phone:941-749-7638
Mailing Address - Fax:941-750-9812
Practice Address - Street 1:4012 9TH AVE W
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34205-1706
Practice Address - Country:US
Practice Address - Phone:941-749-7638
Practice Address - Fax:941-750-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-22
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL115071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty