Provider Demographics
NPI:1972996981
Name:PEREZ NIEVES, SUSEL IVET
Entity Type:Individual
Prefix:
First Name:SUSEL
Middle Name:IVET
Last Name:PEREZ NIEVES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:618 ATLANTIC SHORES BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:HALLANDALE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33009-2596
Mailing Address - Country:US
Mailing Address - Phone:954-456-7900
Mailing Address - Fax:954-362-2404
Practice Address - Street 1:618 ATLANTIC SHORES BLVD STE 101
Practice Address - Street 2:
Practice Address - City:HALLANDALE BEACH
Practice Address - State:FL
Practice Address - Zip Code:33009-2596
Practice Address - Country:US
Practice Address - Phone:954-456-7900
Practice Address - Fax:954-362-2404
Is Sole Proprietor?:No
Enumeration Date:2015-03-16
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN230091223G0001X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice