Provider Demographics
NPI:1437932852
Name:PEREZ, ALEXIS JR (DDS)
Entity Type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:
Last Name:PEREZ
Suffix:JR
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 1:1019 CLAY ST
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-3253
Mailing Address - Country:US
Mailing Address - Phone:321-316-8683
Mailing Address - Fax:
Practice Address - Street 1:4160 HIGHLAND AVE STE J
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:CA
Practice Address - Zip Code:92346-2750
Practice Address - Country:US
Practice Address - Phone:312-274-4546
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-17
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA1091731223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program