Provider Demographics
NPI:1386051266
Name:PERRY, MARK W (DMD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:W
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 1:635 ORCHARD HILL DR
Mailing Address - Street 2:
Mailing Address - City:CLARKESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30523-1376
Mailing Address - Country:US
Mailing Address - Phone:706-288-7112
Mailing Address - Fax:
Practice Address - Street 1:603 CLARKESVILLE ST
Practice Address - Street 2:
Practice Address - City:CORNELIA
Practice Address - State:GA
Practice Address - Zip Code:30531-2907
Practice Address - Country:US
Practice Address - Phone:706-778-1790
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-12
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN014832122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist