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NPI Code Detail

MEDICARE: DR. LOUIS TYLER PERRY D.M.D.

MEDICARE:  DR. LOUIS TYLER PERRY  D.M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1122300000XDentist151093NC

General Provider Information

NPI Number : 1699128793
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LOUIS TYLER PERRY D.M.D.
Provider Business Mailing Address
First Line : 3241 LAKESHORE DR
Second Line :
City : FLORENCE
State : SC
Zip : 29501-8231
Country : US
Telephone Number : 843-615-2503
Fax Number :
Provider Business Practice Location Address
First Line : 600 COUNTRY CLUB RD
Second Line :
City : LUMBERTON
State : NC
Zip : 28360-0428
Country : US
Telephone Number : 910-737-6457
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/13/2016
Last Update Date : 07/13/2016

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Directions to “ DR. LOUIS TYLER PERRY D.M.D.” Practice Location

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