Provider Demographics
NPI:1275634578
Name:PEREZ, EDUARDO JR (DDS)
Entity Type:Individual
Prefix:
First Name:EDUARDO
Middle Name:
Last Name:PEREZ
Suffix:JR
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8219 OLDE VILLAGE DR.
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78250
Mailing Address - Country:US
Mailing Address - Phone:210-307-7709
Mailing Address - Fax:
Practice Address - Street 1:10722 POTRANCO RD
Practice Address - Street 2:SUITE 109
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78251-3314
Practice Address - Country:US
Practice Address - Phone:210-307-7709
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20174122300000X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXGO166886OtherDPS
TXGO166886OtherDPS