Provider Demographics
NPI:1750059432
Name:PERAZA-URRUTIA, IRENE J (DDS)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:J
Last Name:PERAZA-URRUTIA
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28002 HUNTER CREST LN
Mailing Address - Street 2:
Mailing Address - City:FULSHEAR
Mailing Address - State:TX
Mailing Address - Zip Code:77441-1960
Mailing Address - Country:US
Mailing Address - Phone:281-725-2598
Mailing Address - Fax:
Practice Address - Street 1:4603 HIGHWAY 6 N
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77084-2821
Practice Address - Country:US
Practice Address - Phone:832-427-1998
Practice Address - Fax:832-427-1885
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX376541223G0001X, 122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
No1223G0001XDental ProvidersDentistGeneral Practice