Provider Demographics
NPI:1275002289
Name:PEREZ, LUIS (DMD)
Entity Type:Individual
Prefix:
First Name:LUIS
Middle Name:
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 1:2050 40TH AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-2467
Mailing Address - Country:US
Mailing Address - Phone:772-569-9781
Mailing Address - Fax:
Practice Address - Street 1:2050 40TH AVE STE 6
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-2467
Practice Address - Country:US
Practice Address - Phone:772-569-9781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN238561223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice