Organization
EVAN L PERRY DDS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. EVAN LEE PERRY DDS (PRESIDENT)
(801) 225-7111
Entity
Organization
Contact information
Practice address
320 RIVER PARK DR, SUITE 225, PROVO, UT 84604-6060
(801) 225-7111
(801) 764-9777
Mailing address
320 RIVER PARK DR, SUITE 225, PROVO, UT 84604-6060
(801) 225-7111
(801) 764-9777
Taxonomy
Speciality
Code
Description
License number
State
1223G0001X
General Practice Dentistry
Primary
142103
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
528906301003
—
UT
Enumeration date
03/20/2007
Last updated
10/14/2008
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