Healthcare Provider Details

I. General information

NPI: 1750458741
Provider Name (Legal Business Name): PERRY FAMILY DENTISTRY, L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1305 2ND ST
PERRY IA
50220-1511
US

IV. Provider business mailing address

PO BOX 369
PERRY IA
50220-0369
US

V. Phone/Fax

Practice location:
  • Phone: 515-465-3501
  • Fax: 515-465-9390
Mailing address:
  • Phone: 515-465-3501
  • Fax: 515-465-9390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GREGORY DALE STEFFEN
Title or Position: OWNER
Credential: D.D.S.
Phone: 515-465-3501