Provider Demographics
NPI:1295814077
Name:PEREZ, JOSE RICARDO (DMD, MSD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:RICARDO
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DMD, MSD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W GRANT ST APT 5014
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32806-3974
Mailing Address - Country:US
Mailing Address - Phone:407-274-5132
Mailing Address - Fax:
Practice Address - Street 1:785 N ALAFAYA TRL
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32828-7047
Practice Address - Country:US
Practice Address - Phone:407-274-5132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN170081223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics