Provider Demographics
NPI:1861702045
Name:PERRY, MICHAEL JOSEPH (DDS)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:PERRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6133 ROUTE 219 S STE 1003
Mailing Address - Street 2:
Mailing Address - City:ELLICOTTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:14731-9613
Mailing Address - Country:US
Mailing Address - Phone:166-992-3547
Mailing Address - Fax:716-699-2831
Practice Address - Street 1:6133 ROUTE 219 S STE 1003
Practice Address - Street 2:
Practice Address - City:ELLICOTTVILLE
Practice Address - State:NY
Practice Address - Zip Code:14731-9613
Practice Address - Country:US
Practice Address - Phone:166-992-3547
Practice Address - Fax:716-699-2831
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY055543-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist