Provider Demographics
NPI:1679571095
Name:PEREZ-LUNA, JOSE GUADALUPE (DDS)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:GUADALUPE
Last Name:PEREZ-LUNA
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 1:1690 W HOLT AVE
Mailing Address - Street 2:STE A
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-3319
Mailing Address - Country:US
Mailing Address - Phone:909-469-6262
Mailing Address - Fax:909-469-6263
Practice Address - Street 1:1690 W HOLT AVE
Practice Address - Street 2:STE A
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-3319
Practice Address - Country:US
Practice Address - Phone:909-469-6262
Practice Address - Fax:909-469-6263
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-09
Last Update Date:2007-07-08
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-30
Provider Licenses
StateLicense IDTaxonomies
CA371521223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice