Provider Demographics
NPI:1548281173
Name:PERRY, AMBER O (DMD)
Entity type:Individual
Prefix:DR
First Name:AMBER
Middle Name:O
Last Name:PERRY
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 TOWN PARK BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:EVANS
Mailing Address - State:GA
Mailing Address - Zip Code:30809-3471
Mailing Address - Country:US
Mailing Address - Phone:706-288-1100
Mailing Address - Fax:706-288-1060
Practice Address - Street 1:400 TOWN PARK BLVD STE 400
Practice Address - Street 2:
Practice Address - City:EVANS
Practice Address - State:GA
Practice Address - Zip Code:30809-3471
Practice Address - Country:US
Practice Address - Phone:706-288-1100
Practice Address - Fax:706-288-1060
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0122291223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000889787CMedicaid
GA000889787BMedicaid
GA9180557OtherDORAL