Provider Demographics
NPI:1861708554
Name:PERRY, KASEY SCOTT (DDS)
Entity type:Individual
Prefix:MR
First Name:KASEY
Middle Name:SCOTT
Last Name:PERRY
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4115 HERITAGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93619
Mailing Address - Country:US
Mailing Address - Phone:559-906-7341
Mailing Address - Fax:
Practice Address - Street 1:847 W CHILDS AVE
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95341-6862
Practice Address - Country:US
Practice Address - Phone:209-383-5764
Practice Address - Fax:209-383-6624
Is Sole Proprietor?:No
Enumeration Date:2010-08-19
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA595601223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice