Healthcare Provider Details

I. General information

NPI: 1215755665
Provider Name (Legal Business Name): PERRY DO DDS MS CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2024
Last Update Date: 10/02/2024
Certification Date: 10/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4482 BARRANCA PKWY STE 182
IRVINE CA
92604-4706
US

IV. Provider business mailing address

4482 BARRANCA PKWY STE 182
IRVINE CA
92604-4706
US

V. Phone/Fax

Practice location:
  • Phone: 949-552-2288
  • Fax: 949-552-5976
Mailing address:
  • Phone: 949-552-2288
  • Fax: 949-552-5976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. TRI MINH DO
Title or Position: ORTHODONTIST
Credential: DDS MS
Phone: 714-403-8850