Provider Demographics
NPI:1982115317
Name:LARA A PERRY DDS PA
Entity Type:Organization
Organization Name:LARA A PERRY DDS PA
Other - Org Name:HILL COUNTRY DENTAL NORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:LARA
Authorized Official - Middle Name:ALEXANDRA
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:830-626-1002
Mailing Address - Street 1:1929 W STATE HIGHWAY 46 # 102
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78132-5245
Mailing Address - Country:US
Mailing Address - Phone:830-626-1002
Mailing Address - Fax:
Practice Address - Street 1:1929 W STATE HIGHWAY 46 # 102
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-5245
Practice Address - Country:US
Practice Address - Phone:830-626-1002
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-12
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22207261QD0000X
332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies