Healthcare Provider Details

I. General information

NPI: 1922033190
Provider Name (Legal Business Name): PAUL C. PERRY D.D.S., M.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3109 MAPLEWOOD DR
SULPHUR LA
70663-6201
US

IV. Provider business mailing address

3109 MAPLEWOOD DR
SULPHUR LA
70663-6201
US

V. Phone/Fax

Practice location:
  • Phone: 337-625-5330
  • Fax: 337-625-5335
Mailing address:
  • Phone: 337-625-5330
  • Fax: 337-625-5335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number4372
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: