Provider Demographics
NPI:1013072826
Name:PEREZ, PATTIE LUCAS (RDH)
Entity Type:Individual
Prefix:MRS
First Name:PATTIE
Middle Name:LUCAS
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RDH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91-784 LAUNAHELE ST
Mailing Address - Street 2:
Mailing Address - City:EWA BEACH
Mailing Address - State:HI
Mailing Address - Zip Code:96706-4755
Mailing Address - Country:US
Mailing Address - Phone:808-685-5520
Mailing Address - Fax:
Practice Address - Street 1:400 SAND ISLAND ACCESS RD
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96819
Practice Address - Country:US
Practice Address - Phone:808-842-2930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3159124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3159OtherHYGIENE LICENSE