Provider Demographics
NPI:1912055955
Name:PERRY, JOHN J (DMD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:J
Last Name:PERRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:JEFF
Other - Middle Name:
Other - Last Name:PERRY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:PO BOX 247
Mailing Address - Street 2:100 1ST BAPTIST CHURCH RD.
Mailing Address - City:WHITLEY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:42653-0247
Mailing Address - Country:US
Mailing Address - Phone:606-376-5601
Mailing Address - Fax:606-376-3088
Practice Address - Street 1:100 1ST BAPTIST CHURCH RD.
Practice Address - Street 2:
Practice Address - City:WHITLEY CITY
Practice Address - State:KY
Practice Address - Zip Code:42653-0247
Practice Address - Country:US
Practice Address - Phone:606-376-5601
Practice Address - Fax:606-376-3088
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY44631223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY6004463300Medicaid