Provider Demographics
NPI:1740204023
Name:PEREZ, LUIS AUGUSTO (DDS,MS,PC)
Entity Type:Individual
Prefix:DR
First Name:LUIS
Middle Name:AUGUSTO
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DDS,MS,PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2222 S LINDEN RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48532-5475
Mailing Address - Country:US
Mailing Address - Phone:810-230-1311
Mailing Address - Fax:810-230-1314
Practice Address - Street 1:2222 S LINDEN RD
Practice Address - Street 2:SUITE D
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48532-5475
Practice Address - Country:US
Practice Address - Phone:810-230-1311
Practice Address - Fax:810-230-1314
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2022-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI29010174871223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics