Healthcare Provider Details

I. General information

NPI: 1598679052
Provider Name (Legal Business Name): PERRY PRACTICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 BARNWOOD DR
EDGEWOOD KY
41017-2585
US

IV. Provider business mailing address

155 BARNWOOD DR
EDGEWOOD KY
41017-2585
US

V. Phone/Fax

Practice location:
  • Phone: 859-667-1398
  • Fax:
Mailing address:
  • Phone: 859-667-1398
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOSEPH SHIPPEE
Title or Position: CREDENTIALING MANAGER
Credential:
Phone: 904-472-3839