Provider Demographics
NPI:1184357733
Name:PEREZ GONZALEZ, JAVIER JOSAE (DMD)
Entity type:Individual
Prefix:
First Name:JAVIER
Middle Name:JOSAE
Last Name:PEREZ GONZALEZ
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 1:1233 EAGLES LANDING PKWY STE G
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-6399
Mailing Address - Country:US
Mailing Address - Phone:770-872-0728
Mailing Address - Fax:
Practice Address - Street 1:1233 EAGLES LANDING PKWY STE G
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-6399
Practice Address - Country:US
Practice Address - Phone:770-872-0728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN122762122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist