Provider Demographics
NPI:1013066448
Name:MICHAEL S. PEREZ D.D.S., P.C.
Entity Type:Organization
Organization Name:MICHAEL S. PEREZ D.D.S., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:PEREZ
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:219-836-5787
Mailing Address - Street 1:625 RIDGE RD STE B
Mailing Address - Street 2:
Mailing Address - City:MUNSTER
Mailing Address - State:IN
Mailing Address - Zip Code:46321-1695
Mailing Address - Country:US
Mailing Address - Phone:219-836-5787
Mailing Address - Fax:219-836-4823
Practice Address - Street 1:625 RIDGE RD STE B
Practice Address - Street 2:
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-1695
Practice Address - Country:US
Practice Address - Phone:219-836-5787
Practice Address - Fax:219-836-4823
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN120097751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty