Provider Demographics
NPI:1316186380
Name:PEREIRA, RAUL ALCIDES (DMD)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:ALCIDES
Last Name:PEREIRA
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 1:324 W ROOSEVELT BLVD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19120-4121
Mailing Address - Country:US
Mailing Address - Phone:215-888-3791
Mailing Address - Fax:
Practice Address - Street 1:324 W ROOSEVELT BLVD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19120-4121
Practice Address - Country:US
Practice Address - Phone:215-888-3791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-13
Last Update Date:2009-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS037770122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist