Provider Demographics
NPI:1639390107
Name:PEREZ, MARVIN DANILO (DDS)
Entity Type:Individual
Prefix:DR
First Name:MARVIN
Middle Name:DANILO
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 1:5546 NEWBRIAR WAY
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-8799
Mailing Address - Country:US
Mailing Address - Phone:310-908-8242
Mailing Address - Fax:
Practice Address - Street 1:17185 ARROW BLVD
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92335-3972
Practice Address - Country:US
Practice Address - Phone:909-822-4777
Practice Address - Fax:909-822-2926
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA530961223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice