Provider Demographics
NPI:1972193480
Name:PEREZ MAGIN, ALIEN
Entity Type:Individual
Prefix:
First Name:ALIEN
Middle Name:
Last Name:PEREZ MAGIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8410 FOX HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:PORT RICHEY
Mailing Address - State:FL
Mailing Address - Zip Code:34668-4212
Mailing Address - Country:US
Mailing Address - Phone:727-359-4990
Mailing Address - Fax:
Practice Address - Street 1:10083 US HIGHWAY 19
Practice Address - Street 2:
Practice Address - City:PORT RICHEY
Practice Address - State:FL
Practice Address - Zip Code:34668-3742
Practice Address - Country:US
Practice Address - Phone:727-868-0200
Practice Address - Fax:727-868-1855
Is Sole Proprietor?:No
Enumeration Date:2021-01-20
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDH23717124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist