Provider Demographics
NPI:1548747934
Name:CERVANTES-PEREZ, MOISES EMMANUEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:MOISES
Middle Name:EMMANUEL
Last Name:CERVANTES-PEREZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14830 BOTHELL WAY NE APT 344
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST PARK
Mailing Address - State:WA
Mailing Address - Zip Code:98155-7610
Mailing Address - Country:US
Mailing Address - Phone:559-426-0041
Mailing Address - Fax:
Practice Address - Street 1:17103 28TH DR NE STE 104
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98271-4830
Practice Address - Country:US
Practice Address - Phone:360-208-0492
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-27
Last Update Date:2018-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA608634621223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice