Provider Demographics
NPI:1306925383
Name:PERRY, DANIEL M (DDS)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:M
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 1:4301 LAKE STREET
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-4309
Mailing Address - Country:US
Mailing Address - Phone:337-478-0812
Mailing Address - Fax:337-478-0893
Practice Address - Street 1:4301 LAKE STREET
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4309
Practice Address - Country:US
Practice Address - Phone:337-478-0812
Practice Address - Fax:337-478-0893
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-02
Last Update Date:2014-10-24
Deactivation Date:2014-08-22
Deactivation Code:
Reactivation Date:2014-10-24
Provider Licenses
StateLicense IDTaxonomies
LA56521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice