Provider Demographics
NPI:1487649083
Name:PEREZ, LUIS A (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:A
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DMD, MS
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Mailing Address - Street 1:EDIF MEDICOS DE DIEGO
Mailing Address - Street 2:14-E DE DIEGO ST. STE. 202
Mailing Address - City:MAYAGUEZ
Mailing Address - State:PR
Mailing Address - Zip Code:00680-4890
Mailing Address - Country:US
Mailing Address - Phone:787-831-3555
Mailing Address - Fax:787-831-3838
Practice Address - Street 1:EDIF MEDICOS DE DIEGO
Practice Address - Street 2:14-E DE DIEGO ST. STE. 202
Practice Address - City:MAYAGUEZ
Practice Address - State:PR
Practice Address - Zip Code:00680-4890
Practice Address - Country:US
Practice Address - Phone:787-831-3555
Practice Address - Fax:787-831-3838
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PR7791223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics