| Evan L Perry Dds Pc | |
|
320 River Park Dr Suite 225 Provo UT 84604-6060 | |
| (801) 225-7111 | |
| (801) 764-9777 |
| Full Name | Evan L Perry Dds Pc |
|---|---|
| Speciality | Dentist - General Practice |
| Location | 320 River Park Dr, Provo, Utah |
| Authorized Official Name and Position | Evan Lee Perry (PRESIDENT) |
| Authorized Official Contact | 8012257111 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Evan L Perry Dds Pc 320 River Park Dr Suite 225 Provo UT 84604-6060 Ph: (801) 225-7111 | Evan L Perry Dds Pc 320 River Park Dr Suite 225 Provo UT 84604-6060 Ph: (801) 225-7111 |
| NPI Number | 1134244734 |
|---|---|
| Provider Enumeration Date | 03/20/2007 |
| Last Update Date | 10/14/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134244734 | NPI | - | NPPES |
| 528906301003 | Medicaid | UT |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1223G0001X | Dentist - General Practice | 142103 (Utah) | Primary |
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