Provider Demographics
NPI:1023325198
Name:PERRY, BENTON J (DMD)
Entity type:Individual
Prefix:DR
First Name:BENTON
Middle Name:J
Last Name:PERRY
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 PRESIDENTIAL BLVD APT 706
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1718
Mailing Address - Country:US
Mailing Address - Phone:801-360-4605
Mailing Address - Fax:
Practice Address - Street 1:1600 GARTH BROOKS BLVD STE 150
Practice Address - Street 2:
Practice Address - City:YUKON
Practice Address - State:OK
Practice Address - Zip Code:73099-7412
Practice Address - Country:US
Practice Address - Phone:055-785-2344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-09
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK68901223G0001X
OK1021223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice