Provider Demographics
NPI:1821239484
Name:PEREZ-WEST, CLEMENTINA (DDS)
Entity Type:Individual
Prefix:DR
First Name:CLEMENTINA
Middle Name:
Last Name:PEREZ-WEST
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 1:11400 ROCKVILLE PIKE STE 509
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3024
Mailing Address - Country:US
Mailing Address - Phone:301-881-7646
Mailing Address - Fax:301-881-7688
Practice Address - Street 1:11400 ROCKVILLE PIKE STE 509
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3024
Practice Address - Country:US
Practice Address - Phone:301-881-7646
Practice Address - Fax:301-881-7688
Is Sole Proprietor?:No
Enumeration Date:2009-03-11
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11766122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist