Provider Demographics
NPI:1760852917
Name:PEREZ, VICTOR EDUARDO (DDS)
Entity Type:Individual
Prefix:
First Name:VICTOR
Middle Name:EDUARDO
Last Name:PEREZ
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 1:22108 SCHOOLCRAFT ST
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2346
Mailing Address - Country:US
Mailing Address - Phone:818-261-2514
Mailing Address - Fax:
Practice Address - Street 1:10630 TOWN CENTER DR STE 125
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-6889
Practice Address - Country:US
Practice Address - Phone:909-483-3131
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-30
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO00202682122300000X
UT13661508-99261223P0300X
CADDS651831223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics
No122300000XDental ProvidersDentist