Provider Demographics
NPI:1013935212
Name:PEREZ, JESUS (DMD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
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 1:701 W MONTROSE ST
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-2121
Mailing Address - Country:US
Mailing Address - Phone:352-394-5121
Mailing Address - Fax:352-394-6666
Practice Address - Street 1:701 W MONTROSE ST
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-2121
Practice Address - Country:US
Practice Address - Phone:352-394-5121
Practice Address - Fax:352-394-6666
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN170981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice