Michael Joseph Perry, D.D.S.
Individual provider Active NPI Dentist · Ellicottville, NY
NPI 1861702045 · NPPES record last updated Jul 30, 2024
Key facts
- NPI
- 1861702045
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Dentist 122300000X
- License
- 055543-1 (NY)
- Practice address
- 6133 Route 219 S Ste 1003
Ellicottville, NY 14731-9613 - Phone
- (166) 992-3547
- Fax
- (716) 699-2831
- NPI assigned
- Oct 20, 2010
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: No · Hospice: Yes
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160222001789 | NY | Order and Referring Only - Dentist |
6507161031 |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055543-1 | NY | MD | Dentist |
| 055543 | NY | MD | Physical Therapist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 055543-1 | NY | Yes |
Addresses
Primary practice location
6133 Route 219 S Ste 1003
Ellicottville, NY 14731-9613
Mailing address
6133 Route 219 S Ste 1003
Ellicottville, NY 14731-9613
Phone (166) 992-3547
Other providers in Ellicottville, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 30, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.