Provider Demographics
NPI:1083627889
Name:PEREZ, YADIRA EILEEN (DMD)
Entity Type:Individual
Prefix:DR
First Name:YADIRA
Middle Name:EILEEN
Last Name: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:EX1 CALLE ENSENADA
Mailing Address - Street 2:EL ALAMO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4511
Mailing Address - Country:US
Mailing Address - Phone:787-721-0887
Mailing Address - Fax:
Practice Address - Street 1:1607 AVE PONCE DE LEON
Practice Address - Street 2:SUITE LM 21
Practice Address - City:SANTURCE
Practice Address - State:PR
Practice Address - Zip Code:00909-1820
Practice Address - Country:US
Practice Address - Phone:787-721-0887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR24531223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice