Provider Demographics
NPI:1518365402
Name:OMAR PEREZ-MURGUIA,DDS,PA
Entity Type:Organization
Organization Name:OMAR PEREZ-MURGUIA,DDS,PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:OMAR
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ-MURGUIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-552-6446
Mailing Address - Street 1:9835 SW 40TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-3993
Mailing Address - Country:US
Mailing Address - Phone:305-552-6446
Mailing Address - Fax:305-225-2880
Practice Address - Street 1:9835 SW 40TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33165-3993
Practice Address - Country:US
Practice Address - Phone:305-552-6446
Practice Address - Fax:305-225-2880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-09
Last Update Date:2014-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN157271223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL070896800Medicaid