Provider Demographics
NPI:1821108127
Name:PEREZ, ANTHONY L (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:L
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:ANTHONY
Other - Middle Name:L
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:2807 LOMS VISTA RD
Mailing Address - Street 2:#202
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003
Mailing Address - Country:US
Mailing Address - Phone:805-653-6377
Mailing Address - Fax:805-653-2627
Practice Address - Street 1:2807 LOMS VISTA RD
Practice Address - Street 2:#202
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003
Practice Address - Country:US
Practice Address - Phone:805-653-6377
Practice Address - Fax:805-653-2627
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist