Provider Demographics
NPI:1457470536
Name:PEREZOUS, LETICIA F (DDS, MS)
Entity Type:Individual
Prefix:DR
First Name:LETICIA
Middle Name:F
Last Name:PEREZOUS
Suffix:
Gender:F
Credentials:DDS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1310 VILLAGE GARDEN DR
Mailing Address - Street 2:
Mailing Address - City:MISSOURI CITY
Mailing Address - State:TX
Mailing Address - Zip Code:77459-1513
Mailing Address - Country:US
Mailing Address - Phone:281-499-7182
Mailing Address - Fax:
Practice Address - Street 1:7676 WOODWAY DR STE 310
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77063-1523
Practice Address - Country:US
Practice Address - Phone:713-781-4100
Practice Address - Fax:713-781-7877
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX218871223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics