Provider Demographics
NPI:1235204520
Name:PEREZ, MIGUEL HUGO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MIGUEL
Middle Name:HUGO
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:HUGO
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:5404 N HOYNE AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60625-1112
Mailing Address - Country:US
Mailing Address - Phone:773-936-8030
Mailing Address - Fax:
Practice Address - Street 1:1411 W IRVING PARK RD
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1920
Practice Address - Country:US
Practice Address - Phone:773-404-8030
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL01921518122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1003298Medicaid