Provider Demographics
NPI:1215015748
Name:PERRY, CHAD C (DDS)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:C
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 1:881 N TARRANT PKWY
Mailing Address - Street 2:
Mailing Address - City:KELLER
Mailing Address - State:TX
Mailing Address - Zip Code:76248-6860
Mailing Address - Country:US
Mailing Address - Phone:817-812-2082
Mailing Address - Fax:817-812-2830
Practice Address - Street 1:881 N TARRANT PARKWAY
Practice Address - Street 2:
Practice Address - City:KELLER
Practice Address - State:TX
Practice Address - Zip Code:76248-6860
Practice Address - Country:US
Practice Address - Phone:817-812-2082
Practice Address - Fax:817-812-2830
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX210371223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice