MEDICARE: DR. TARA F PERRY DMD

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	DN012548	GA

General Provider Information

NPI Number	:	1891821252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARA F PERRY DMD

Provider Business Mailing Address
First Line	:	1300 PEACHTREE INDUSTRIAL BLVD
Second Line	:	SUITE 4103
City	:	SUWANEE
State	:	GA
Zip	:	30024-4539
Country	:	US
Telephone Number	:	770-831-5568
Fax Number	:	770-831-5527

Provider Business Practice Location Address
First Line	:	1300 PEACHTREE INDUSTRIAL BLVD
Second Line	:	SUITE 4103
City	:	SUWANEE
State	:	GA
Zip	:	30024-4539
Country	:	US
Telephone Number	:	770-831-5568
Fax Number	:	770-831-5527

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/09/2010

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