Provider Demographics
NPI:1669665485
Name:PEREZ, LOSCAR NUMAEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:LOSCAR
Middle Name:NUMAEL
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 1:1545 POWERS FERRY RD SE STE 220
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30067-9401
Mailing Address - Country:US
Mailing Address - Phone:770-980-9404
Mailing Address - Fax:
Practice Address - Street 1:801 FLORIDA RD UNIT 2
Practice Address - Street 2:
Practice Address - City:DURANGO
Practice Address - State:CO
Practice Address - Zip Code:81301-4775
Practice Address - Country:US
Practice Address - Phone:970-259-0113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-24
Last Update Date:2014-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODEN-95271223P0700X
GADN0146851223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics