Provider Demographics
NPI:1578780425
Name:PEREZ, RAFAEL ANTONIO (DDS)
Entity Type:Individual
Prefix:
First Name:RAFAEL
Middle Name:ANTONIO
Last Name: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 1:2301 MIDWESTERN PKWY
Mailing Address - Street 2:STE. #110
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-2344
Mailing Address - Country:US
Mailing Address - Phone:940-692-2851
Mailing Address - Fax:940-691-1520
Practice Address - Street 1:2301 MIDWESTERN PKWY
Practice Address - Street 2:STE. #110
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76308-2344
Practice Address - Country:US
Practice Address - Phone:940-692-2851
Practice Address - Fax:940-691-1520
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX189681223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice