Active NPI
Randall Scott Perry, DDS
- Dentist
- Statesville, NC
National Provider Identifier
1306268016
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6074
- Practice address
- 1132 Davie Avenue
Statesville, NC 28677 - Phone
- (704) 881-0990
- Fax
- (704) 872-8541
- NPI assigned
- Jan 15, 2014
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 6074 | NC | Primary |
Addresses
Primary practice location
1132 Davie Avenue
Statesville, NC 28677
Mailing address
1132 Davie Avenue
Statesville, NC 28677
Phone (704) 881-0990
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1033325014 | Other | NC | NPI TYPE II |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6074 | NC | MD | Speech-Language Pathologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Randall S Perry DDS PA | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Periodontics
- Statesville, NC
- NPI 1033325014
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1389744000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1389916800000",
"number": "1306268016",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1132 DAVIE AVENUE",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "28677",
"telephone_number": "704-881-0990",
"fax_number": "704-872-8541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1132 DAVIE AVENUE",
"city": "STATESVILLE",
"state": "NC",
"postal_code": "28677",
"telephone_number": "704-881-0990",
"fax_number": "704-872-8541"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PERRY",
"first_name": "RANDALL",
"middle_name": "SCOTT",
"name_prefix": "Dr.",
"credential": "DDS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-01-15",
"last_updated": "2014-01-17",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NC",
"license": "6074",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NPI TYPE II",
"identifier": "1033325014",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Statesville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 17, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.