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General NPI Number Information
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NPI Number | 1275549032
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Entity Type | Organization
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Legal Business Name | PERRY DENTAL GROUP
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Dates
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Enumeration Date | 08/01/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1606 W FIR ST
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City | PERRY
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State | OK
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Zip | 73077-5800
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Country | US
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Telephone | 580-336-6500
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Fax | 580-336-6502
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Provider Business Mailing Address
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Address Line | 1606 W FIR ST
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City | PERRY
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State | OK
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Zip | 73077-5800
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Country | US
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Telephone | 580-336-6500
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Fax | 580-336-6502
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Authorized Official
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Title or Position | DOCTOR
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Name | DR. JAMES V DEWHURST
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Credential | DDS
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Telephone | 580-336-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 4922
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License Number State | OK
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