Provider Demographics
NPI:1407125651
Name:PEREZ, RAUL D (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAUL
Middle Name:D
Last Name:PEREZ
Suffix:
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 1:615 CALLE CIELO
Mailing Address - Street 2:
Mailing Address - City:NIPOMO
Mailing Address - State:CA
Mailing Address - Zip Code:93444-9593
Mailing Address - Country:US
Mailing Address - Phone:530-776-7231
Mailing Address - Fax:805-904-6989
Practice Address - Street 1:1163 W GRAND AVE
Practice Address - Street 2:
Practice Address - City:GROVER BEACH
Practice Address - State:CA
Practice Address - Zip Code:93433-2149
Practice Address - Country:US
Practice Address - Phone:805-904-6979
Practice Address - Fax:805-904-6989
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-16
Last Update Date:2016-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA610461223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice