Provider Demographics
NPI:1790014694
Name:PERDOMO, ROBERT LUIS III (DMD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LUIS
Last Name:PERDOMO
Suffix:III
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 GIRALDA AVENUE
Mailing Address - Street 2:
Mailing Address - City:CORAL GABLES
Mailing Address - State:FL
Mailing Address - Zip Code:33134-5013
Mailing Address - Country:US
Mailing Address - Phone:305-446-5571
Mailing Address - Fax:305-446-7437
Practice Address - Street 1:260 GIRALDA AVE
Practice Address - Street 2:
Practice Address - City:CORAL GABLES
Practice Address - State:FL
Practice Address - Zip Code:33134-5013
Practice Address - Country:US
Practice Address - Phone:305-446-5571
Practice Address - Fax:305-446-7437
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-24
Last Update Date:2009-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN13546122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist