Provider Demographics
NPI:1043217516
Name:PEREZ, NELSON A (DMD)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:DR
Other - First Name:NELSON
Other - Middle Name:A
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DMD
Mailing Address - Street 1:CALLE LAUREL 2306
Mailing Address - Street 2:COND. THE TERRACE 10F
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00913
Mailing Address - Country:US
Mailing Address - Phone:787-378-7275
Mailing Address - Fax:787-657-2931
Practice Address - Street 1:CALLE 54 BG 176
Practice Address - Street 2:JARDINES DE RIO GRANDE
Practice Address - City:RIO GRANDE
Practice Address - State:PR
Practice Address - Zip Code:00745
Practice Address - Country:US
Practice Address - Phone:787-887-7281
Practice Address - Fax:787-888-7008
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2277122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR041910OtherLA CRUZ AZUL
PR42292PEOtherTRIPLE S