Provider Demographics
NPI:1760877856
Name:PEREZ-GOLDBERG, KARLA JOSE (DDS)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:JOSE
Last Name:PEREZ-GOLDBERG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:KARLA
Other - Middle Name:
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:293 MAIN AVE
Mailing Address - Street 2:
Mailing Address - City:PASSAIC
Mailing Address - State:NJ
Mailing Address - Zip Code:07055
Mailing Address - Country:US
Mailing Address - Phone:973-471-0099
Mailing Address - Fax:973-396-1840
Practice Address - Street 1:293 MAIN AVE
Practice Address - Street 2:
Practice Address - City:PASSAIC
Practice Address - State:NJ
Practice Address - Zip Code:07055
Practice Address - Country:US
Practice Address - Phone:973-471-0099
Practice Address - Fax:973-396-1840
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-06
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22D1026274001223S0112X
NY060264-011223S0112X
390200000X
NJ06993204E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial Surgery
No1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program