MEDICARE: DR. JOSHUA L PERRY D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	30-023483	OH
2	1223D0004X	Dental Anesthesiology	30.023483	OH

General Provider Information

NPI Number	:	1619255197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSHUA L PERRY D.D.S.

Provider Business Mailing Address
First Line	:	1236 MICHIGAN AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43201-3116
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	305 W 12TH AVE
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43210-1267
Country	:	US
Telephone Number	:	614-292-9731
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/01/2011
Last Update Date	:	09/25/2018

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