Provider Demographics
NPI:1508490921
Name:PEREZ, EVELYN (EVELYN)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:EVELYN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 MALLARD WAY
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61571-8000
Mailing Address - Country:US
Mailing Address - Phone:317-426-0042
Mailing Address - Fax:
Practice Address - Street 1:7725 S EMERSON AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46237-8654
Practice Address - Country:US
Practice Address - Phone:317-426-0042
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY105081223P0221X
IN12013910A1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry