Provider Demographics
NPI:1538478623
Name:PEREZ-SUAREZ, TERESA
Entity Type:Individual
Prefix:DR
First Name:TERESA
Middle Name:
Last Name:PEREZ-SUAREZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16693 SW 54TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33185-4156
Mailing Address - Country:US
Mailing Address - Phone:305-220-5686
Mailing Address - Fax:305-412-7728
Practice Address - Street 1:16693 SW 54TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33185-4156
Practice Address - Country:US
Practice Address - Phone:305-220-5686
Practice Address - Fax:305-412-7728
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN176091223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice