Provider Demographics
NPI:1235301649
Name:PEREZ, ERNESTO JESUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:ERNESTO
Middle Name:JESUS
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 SW 107TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3605
Mailing Address - Country:US
Mailing Address - Phone:305-220-9393
Mailing Address - Fax:305-220-4411
Practice Address - Street 1:3201 SW 107TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3605
Practice Address - Country:US
Practice Address - Phone:305-220-9393
Practice Address - Fax:305-220-4411
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-25
Last Update Date:2008-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11197122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist