Provider Demographics
NPI:1922181742
Name:PEREZ, MARK RICHARD (DDS)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:RICHARD
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18708 OLNEY MILL RD
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832
Mailing Address - Country:US
Mailing Address - Phone:301-260-1571
Mailing Address - Fax:
Practice Address - Street 1:11503 SUNRISE VALLEY DR
Practice Address - Street 2:
Practice Address - City:RESTON
Practice Address - State:VA
Practice Address - Zip Code:20191
Practice Address - Country:US
Practice Address - Phone:703-860-3200
Practice Address - Fax:703-476-6794
Is Sole Proprietor?:No
Enumeration Date:2006-10-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401008179122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist