Provider Demographics
NPI:1801971312
Name:PEREZ, GILBERTO LUIS (DENTIST)
Entity type:Individual
Prefix:DR
First Name:GILBERTO
Middle Name:LUIS
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:DR
Other - First Name:GILBERTO
Other - Middle Name:LUIS
Other - Last Name:PEREZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DENTIST
Mailing Address - Street 1:2126 CALLE SIRCE
Mailing Address - Street 2:ALTO APOLO
Mailing Address - City:GUAYNABO
Mailing Address - State:PR
Mailing Address - Zip Code:00969-4935
Mailing Address - Country:US
Mailing Address - Phone:787-789-5168
Mailing Address - Fax:787-767-2202
Practice Address - Street 1:2126 CALLE SIRCE
Practice Address - Street 2:ALTO APOLO
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00969-4935
Practice Address - Country:US
Practice Address - Phone:787-789-5168
Practice Address - Fax:787-767-2202
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR16441223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice