Provider Demographics
NPI:1619347747
Name:PEREZ, FEDERICO JOSE (DMD)
Entity Type:Individual
Prefix:DR
First Name:FEDERICO
Middle Name:JOSE
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 AMESBURY ST
Mailing Address - Street 2:#203
Mailing Address - City:LAWRENCE
Mailing Address - State:MA
Mailing Address - Zip Code:01840-1321
Mailing Address - Country:US
Mailing Address - Phone:978-686-8500
Mailing Address - Fax:
Practice Address - Street 1:100 AMESBURY ST
Practice Address - Street 2:#203
Practice Address - City:LAWRENCE
Practice Address - State:MA
Practice Address - Zip Code:01840-1321
Practice Address - Country:US
Practice Address - Phone:978-686-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-01
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN1857085122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist