Provider Demographics
NPI:1922667872
Name:PEREZ, SANDY (DMD)
Entity Type:Individual
Prefix:DR
First Name:SANDY
Middle Name:
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HARRISON AVE APT 1-607
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2821
Mailing Address - Country:US
Mailing Address - Phone:305-333-5981
Mailing Address - Fax:
Practice Address - Street 1:1842 BEACON ST STE 304
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-1900
Practice Address - Country:US
Practice Address - Phone:617-928-8746
Practice Address - Fax:617-730-8482
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MADN11084541223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice