Provider Demographics
NPI:1235250176
Name:PERRY, ZACHARY ETHAN (DMD)
Entity type:Individual
Prefix:
First Name:ZACHARY
Middle Name:ETHAN
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 1:48TH MDG, UNIT 5115
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09461
Mailing Address - Country:GB
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:48TH MDG, UNIT 5115, APO, AE 09461
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:MT
Practice Address - Zip Code:09461
Practice Address - Country:US
Practice Address - Phone:406-731-3637
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-02
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDD-4046122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist