Provider Demographics
NPI:1770212250
Name:PEREZ MOREJON, LAURA (DMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:PEREZ MOREJON
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 1:9453 SW 174TH ST
Mailing Address - Street 2:
Mailing Address - City:PALMETTO BAY
Mailing Address - State:FL
Mailing Address - Zip Code:33157-5614
Mailing Address - Country:US
Mailing Address - Phone:786-298-4612
Mailing Address - Fax:
Practice Address - Street 1:9453 SW 174TH ST
Practice Address - Street 2:
Practice Address - City:PALMETTO BAY
Practice Address - State:FL
Practice Address - Zip Code:33157-5614
Practice Address - Country:US
Practice Address - Phone:786-298-4612
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-08
Last Update Date:2022-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN268891223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice