Provider Demographics
NPI:1295881654
Name:PEREZ, GREGORY CARL (DMD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:CARL
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 1:230 CENTRE ST
Mailing Address - Street 2:
Mailing Address - City:NUTLEY
Mailing Address - State:NJ
Mailing Address - Zip Code:07110-2877
Mailing Address - Country:US
Mailing Address - Phone:973-667-1095
Mailing Address - Fax:973-667-9611
Practice Address - Street 1:230 CENTRE ST
Practice Address - Street 2:
Practice Address - City:NUTLEY
Practice Address - State:NJ
Practice Address - Zip Code:07110-2877
Practice Address - Country:US
Practice Address - Phone:973-667-1095
Practice Address - Fax:973-667-9611
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJDI16973122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist