Healthcare Provider Details

I. General information

NPI: 1063576551
Provider Name (Legal Business Name): ROBERT DEAN PERRY D.D.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 N MAIN ST
VASSAR MI
48768-1319
US

IV. Provider business mailing address

140 N MAIN ST
VASSAR MI
48768-1319
US

V. Phone/Fax

Practice location:
  • Phone: 989-823-8436
  • Fax: 989-823-2111
Mailing address:
  • Phone: 989-823-8436
  • Fax: 989-823-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number12068
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: