MEDICARE: TAMMY M.E. PERISON 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	1223G0001X	General Practice Dentistry	046824	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000527145002	OTHER	NY	BLUECROSSBLUESHIELD WNY

General Provider Information

NPI Number	:	1811088735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY M.E. PERISON D.D.S.

Provider Business Mailing Address
First Line	:	425 MAIN ST
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-2822
Country	:	US
Telephone Number	:	716-674-5256
Fax Number	:	716-674-5715

Provider Business Practice Location Address
First Line	:	425 MAIN ST
Second Line	:
City	:	WEST SENECA
State	:	NY
Zip	:	14224-2822
Country	:	US
Telephone Number	:	716-674-5256
Fax Number	:	716-674-5715

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

Provider Enumeration Date	:	09/27/2006
Last Update Date	:	07/08/2007

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