Provider Demographics
NPI:1578949426
Name:PERETZ JOBLOVE PERETZ DDS PA
Entity Type:Organization
Organization Name:PERETZ JOBLOVE PERETZ DDS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:PERETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:954-981-4500
Mailing Address - Street 1:4801 HOLLYWOOD BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33021-6545
Mailing Address - Country:US
Mailing Address - Phone:954-981-4500
Mailing Address - Fax:
Practice Address - Street 1:4801 HOLLYWOOD BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-6545
Practice Address - Country:US
Practice Address - Phone:954-981-4500
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-03
Last Update Date:2015-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN10594122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty