Provider Demographics
NPI:1346077260
Name:PERRY, JACOB (DDS)
Entity type:Individual
Prefix:
First Name:JACOB
Middle Name:
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 1:4972 HIGHWAY 58 STE 114
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-1868
Mailing Address - Country:US
Mailing Address - Phone:423-894-5223
Mailing Address - Fax:
Practice Address - Street 1:4972 HIGHWAY 58 STE 114
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-1868
Practice Address - Country:US
Practice Address - Phone:423-894-5223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-16
Last Update Date:2024-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN126231223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice