Provider Demographics
NPI:1518103761
Name:PEREZ, KENDY SHIRLEY (DENTAL AST)
Entity Type:Individual
Prefix:
First Name:KENDY
Middle Name:SHIRLEY
Last Name:PEREZ
Suffix:
Gender:F
Credentials:DENTAL AST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 WRENWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93638-1827
Mailing Address - Country:US
Mailing Address - Phone:559-270-2689
Mailing Address - Fax:
Practice Address - Street 1:1316 WRENWOOD WAY
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93638-1827
Practice Address - Country:US
Practice Address - Phone:559-270-2686
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2009-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant