Healthcare Provider Details

I. General information

NPI: 1366463408
Provider Name (Legal Business Name): SECUNDA TAMARA WRIGHT-PERRY D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9507 ATOM ROAD
CLINTON MD
20735-2902
US

IV. Provider business mailing address

9507 ATOM ROAD
CLINTON MD
20735-2902
US

V. Phone/Fax

Practice location:
  • Phone: 301-806-2155
  • Fax: 240-244-2187
Mailing address:
  • Phone: 301-806-2155
  • Fax: 240-244-2187

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number8953
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: