Provider Demographics
NPI:1518337179
Name:PEREZ SIMON, LIDYA DANIELLA (DMD)
Entity Type:Individual
Prefix:
First Name:LIDYA
Middle Name:DANIELLA
Last Name:PEREZ SIMON
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11300 ROCKVILLE PIKE
Mailing Address - Street 2:SUITE 702
Mailing Address - City:NORTH BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3011
Mailing Address - Country:US
Mailing Address - Phone:301-770-2223
Mailing Address - Fax:301-770-2224
Practice Address - Street 1:11300 ROCKVILLE PIKE
Practice Address - Street 2:SUITE 702
Practice Address - City:NORTH BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20852-3011
Practice Address - Country:US
Practice Address - Phone:301-770-2223
Practice Address - Fax:301-770-2224
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-25
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD160491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice