Healthcare Provider Details

I. General information

NPI: 1801852108
Provider Name (Legal Business Name): PERRY DENTAL P.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

114 NORTH MAIN STREET
PERRY MI
48872-0619
US

IV. Provider business mailing address

PO BOX 619
PERRY MI
48872-0619
US

V. Phone/Fax

Practice location:
  • Phone: 517-625-4163
  • Fax: 517-625-5049
Mailing address:
  • Phone: 517-625-4163
  • Fax: 517-625-5049

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. TAMMY A MIKA
Title or Position: OWNER/DENTIST
Credential: DDS
Phone: 517-625-4163