Provider Demographics
NPI:1154332849
Name:PERENA, LORELEI SAMSON (DMD)
Entity Type:Individual
Prefix:DR
First Name:LORELEI
Middle Name:SAMSON
Last Name:PERENA
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 1:406 SUNRISE AVE 240
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-4106
Mailing Address - Country:US
Mailing Address - Phone:916-773-0222
Mailing Address - Fax:916-773-9308
Practice Address - Street 1:699 WASHINGTON BLVD
Practice Address - Street 2:STE. B-8
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95678-1570
Practice Address - Country:US
Practice Address - Phone:916-773-0222
Practice Address - Fax:916-773-9308
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-10
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA492581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice