Provider Demographics
NPI:1861645327
Name:JOHN B PEREZ DDS
Entity Type:Organization
Organization Name:JOHN B PEREZ DDS
Other - Org Name:GENERAL CORPORATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:BARRON
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:408-847-4550
Mailing Address - Street 1:7880 WREN AVE STE F162
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7802
Mailing Address - Country:US
Mailing Address - Phone:408-847-4550
Mailing Address - Fax:408-848-1784
Practice Address - Street 1:7880 WREN AVE STE F162
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-7802
Practice Address - Country:US
Practice Address - Phone:408-847-4550
Practice Address - Fax:408-848-1784
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28478261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1417089541Medicaid