Provider Demographics
NPI:1801035852
Name:MEDINA-PEREZ, GIOCONDA LORENZA (DDS)
Entity Type:Individual
Prefix:DR
First Name:GIOCONDA
Middle Name:LORENZA
Last Name:MEDINA-PEREZ
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1897 AUTUMN GLEN DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:MI
Mailing Address - Zip Code:48843-6110
Mailing Address - Country:US
Mailing Address - Phone:810-632-4859
Mailing Address - Fax:
Practice Address - Street 1:1897 AUTUMN GLEN DR
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:MI
Practice Address - Zip Code:48843-6110
Practice Address - Country:US
Practice Address - Phone:810-632-4859
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI2901019289122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist