Provider Demographics
NPI:1053549626
Name:PERRY, MATTHEW AARON (DMD)
Entity type:Individual
Prefix:
First Name:MATTHEW
Middle Name:AARON
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 1:800 PINE CT
Mailing Address - Street 2:
Mailing Address - City:MCPHERSON
Mailing Address - State:KS
Mailing Address - Zip Code:67460-5246
Mailing Address - Country:US
Mailing Address - Phone:620-241-1610
Mailing Address - Fax:
Practice Address - Street 1:700 N MAPLE ST
Practice Address - Street 2:
Practice Address - City:MCPHERSON
Practice Address - State:KS
Practice Address - Zip Code:67460-3325
Practice Address - Country:US
Practice Address - Phone:620-241-5000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-23
Last Update Date:2009-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS606921223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice