Provider Demographics
NPI:1922214709
Name:PEREZ, PRECIOSA (DDS)
Entity Type:Individual
Prefix:
First Name:PRECIOSA
Middle Name:
Last Name: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 1:344 N WYOMISSING BLVD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-2936
Mailing Address - Country:US
Mailing Address - Phone:610-375-3844
Mailing Address - Fax:
Practice Address - Street 1:344 N WYOMISSING BLVD
Practice Address - Street 2:
Practice Address - City:WYOMISSING
Practice Address - State:PA
Practice Address - Zip Code:19610-2936
Practice Address - Country:US
Practice Address - Phone:610-375-3844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADS0350691223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001883048-0002Medicaid
PA001883048-0001Medicaid