Provider Demographics
NPI:1710468723
Name:PEREZ, HEATHER (DMD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:
Last Name:PEREZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 CAMELLIA CT
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:FL
Mailing Address - Zip Code:32439-6680
Mailing Address - Country:US
Mailing Address - Phone:850-217-9691
Mailing Address - Fax:
Practice Address - Street 1:4579 E HIGHWAY 20 STE 210
Practice Address - Street 2:
Practice Address - City:NICEVILLE
Practice Address - State:FL
Practice Address - Zip Code:32578-9810
Practice Address - Country:US
Practice Address - Phone:850-897-4200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-27
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN23361122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist