Provider Demographics
NPI:1295411304
Name:PEREZ MENDEZ, DALEISY (DMD)
Entity type:Individual
Prefix:
First Name:DALEISY
Middle Name:
Last Name:PEREZ MENDEZ
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 OVERTON GROVE WAY APT 322
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-2393
Mailing Address - Country:US
Mailing Address - Phone:786-619-7408
Mailing Address - Fax:
Practice Address - Street 1:1564 W BRANDON BLVD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4806
Practice Address - Country:US
Practice Address - Phone:786-619-7408
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL28195122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist