Provider Demographics
NPI:1497088983
Name:PEREZ, PEDRO JUAN JR (DMD)
Entity Type:Individual
Prefix:DR
First Name:PEDRO
Middle Name:JUAN
Last Name:PEREZ
Suffix:JR
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 1:1430 SUGGS ST
Mailing Address - Street 2:
Mailing Address - City:ROSSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30741-2223
Mailing Address - Country:US
Mailing Address - Phone:706-657-7575
Mailing Address - Fax:706-866-5512
Practice Address - Street 1:1430 SUGGS ST
Practice Address - Street 2:
Practice Address - City:ROSSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30741-2223
Practice Address - Country:US
Practice Address - Phone:706-657-7575
Practice Address - Fax:706-866-5512
Is Sole Proprietor?:No
Enumeration Date:2009-09-15
Last Update Date:2009-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN013967122300000X
PADS038007122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist