Provider Demographics
NPI:1093484578
Name:PEREZ, CHRYSTOPHER LEWIS
Entity Type:Individual
Prefix:
First Name:CHRYSTOPHER
Middle Name:LEWIS
Last Name:PEREZ
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10660 SOUTHERN HIGHLANDS PKWY STE 110
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89141-4113
Mailing Address - Country:US
Mailing Address - Phone:702-477-0040
Mailing Address - Fax:
Practice Address - Street 1:10660 SOUTHERN HIGHLANDS PKWY STE 110
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89141-4113
Practice Address - Country:US
Practice Address - Phone:702-477-0040
Practice Address - Fax:702-425-9671
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV75211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice