Provider Demographics
NPI:1912969866
Name:PERRY, ROBERT SIDNEY (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:SIDNEY
Last Name:PERRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:532 1ST AVENUE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-0803
Mailing Address - Country:US
Mailing Address - Phone:712-322-3974
Mailing Address - Fax:712-329-4015
Practice Address - Street 1:532 1ST AVENUE
Practice Address - Street 2:SUITE 210
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-0803
Practice Address - Country:US
Practice Address - Phone:712-322-3974
Practice Address - Fax:712-329-4015
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA6274122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0141812Medicaid