Provider Demographics
NPI:1457789448
Name:PERALTA, CHRISTIAN RENE (DMD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTIAN
Middle Name:RENE
Last Name:PERALTA
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 1:2900 CLEAR ACRE LN
Mailing Address - Street 2:SUITE. S
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89512-1712
Mailing Address - Country:US
Mailing Address - Phone:775-337-6453
Mailing Address - Fax:775-337-2843
Practice Address - Street 1:2900 CLEAR ACRE LN
Practice Address - Street 2:SUITE. S
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89512-1712
Practice Address - Country:US
Practice Address - Phone:775-337-6453
Practice Address - Fax:775-337-2843
Is Sole Proprietor?:No
Enumeration Date:2013-10-29
Last Update Date:2013-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV64771223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice