Provider Demographics
NPI:1417440280
Name:PEREZ, JEFFREY ISAIAS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ISAIAS
Last Name:PEREZ
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 1:23255 KIM AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33954-3652
Mailing Address - Country:US
Mailing Address - Phone:305-769-8416
Mailing Address - Fax:
Practice Address - Street 1:1750 TAMIAMI TRL STE 100
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1045
Practice Address - Country:US
Practice Address - Phone:941-702-2198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-07
Last Update Date:2018-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23427122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist