Provider Demographics
NPI:1043218183
Name:BAUTISTA PEREZ, EDDA LIZ (DMD)
Entity Type:Individual
Prefix:DR
First Name:EDDA
Middle Name:LIZ
Last Name:BAUTISTA PEREZ
Suffix:
Gender:F
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:PO BOX 1802
Mailing Address - Street 2:
Mailing Address - City:JUNCOS
Mailing Address - State:PR
Mailing Address - Zip Code:00777-1802
Mailing Address - Country:US
Mailing Address - Phone:787-713-9788
Mailing Address - Fax:
Practice Address - Street 1:CALLE MUNOZ RIVERA #65
Practice Address - Street 2:
Practice Address - City:JUNCOS
Practice Address - State:PR
Practice Address - Zip Code:00777
Practice Address - Country:US
Practice Address - Phone:787-713-9788
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-12
Last Update Date:2019-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX348391223G0001X
PR24381223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice