Provider Demographics
NPI:1235462532
Name:PEREZ MARTINEZ, IRMA DEL CARMEN (DMD, MS)
Entity Type:Individual
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First Name:IRMA
Middle Name:DEL CARMEN
Last Name:PEREZ MARTINEZ
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Gender:F
Credentials:DMD, MS
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Mailing Address - Street 1:2 JAMES WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:PISMO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93449-4973
Mailing Address - Country:US
Mailing Address - Phone:805-773-1600
Mailing Address - Fax:
Practice Address - Street 1:2 JAMES WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-4973
Practice Address - Country:US
Practice Address - Phone:805-773-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-17
Last Update Date:2011-08-12
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Provider Licenses
StateLicense IDTaxonomies
CA579561223P0221X, 1223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics