Provider Demographics
NPI:1407991052
Name:PEREZ, MITZY (DMD)
Entity Type:Individual
Prefix:DR
First Name:MITZY
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
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:PO BOX 195063
Mailing Address - Street 2:
Mailing Address - City:SAN JUAN
Mailing Address - State:PR
Mailing Address - Zip Code:00919-5063
Mailing Address - Country:US
Mailing Address - Phone:787-857-3381
Mailing Address - Fax:787-857-3381
Practice Address - Street 1:9 CALLE BARCELO
Practice Address - Street 2:SUITE 301
Practice Address - City:BARRANQUITAS
Practice Address - State:PR
Practice Address - Zip Code:00794-1779
Practice Address - Country:US
Practice Address - Phone:787-857-3381
Practice Address - Fax:787-857-3381
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR25741223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice