Provider Demographics
NPI:1811088735
Name:PERISON, TAMMY ME (DDS)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:ME
Last Name:PERISON
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST SENECA
Mailing Address - State:NY
Mailing Address - Zip Code:14224-2822
Mailing Address - Country:US
Mailing Address - Phone:716-674-5256
Mailing Address - Fax:716-674-5715
Practice Address - Street 1:425 MAIN ST
Practice Address - Street 2:
Practice Address - City:WEST SENECA
Practice Address - State:NY
Practice Address - Zip Code:14224-2822
Practice Address - Country:US
Practice Address - Phone:716-674-5256
Practice Address - Fax:716-674-5715
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0468241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000527145002OtherBLUECROSSBLUESHIELD WNY