Provider Demographics
NPI:1114988169
Name:PERETZ, AVRAHAM JACOB (DDS)
Entity Type:Individual
Prefix:
First Name:AVRAHAM
Middle Name:JACOB
Last Name:PERETZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:AJ
Other - Middle Name:
Other - Last Name:PERETZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:4400 MACARTHUR BLVD NW
Mailing Address - Street 2:STE #200
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007
Mailing Address - Country:US
Mailing Address - Phone:202-333-0003
Mailing Address - Fax:202-333-0003
Practice Address - Street 1:4400 MACARTHUR BLVD NW
Practice Address - Street 2:STE #200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007
Practice Address - Country:US
Practice Address - Phone:202-333-0003
Practice Address - Fax:202-333-0003
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDEN5945122300000X
MD12144122300000X
PADS030332L122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist