Provider Demographics
NPI:1790179364
Name:PEREZ, YANELIS (DMD)
Entity Type:Individual
Prefix:
First Name:YANELIS
Middle Name:
Last Name:PEREZ
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 1:4047 OKEECHOBEE BLVD
Mailing Address - Street 2:SUITE 219
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-3239
Mailing Address - Country:US
Mailing Address - Phone:561-640-7600
Mailing Address - Fax:
Practice Address - Street 1:4047 OKEECHOBEE BLVD
Practice Address - Street 2:SUITE 219
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-3239
Practice Address - Country:US
Practice Address - Phone:561-640-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-22
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
FLDN212191223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program