Provider Demographics
NPI:1811100399
Name:PEREZ, ALEXIS RAFAEL (DDS)
Entity type:Individual
Prefix:DR
First Name:ALEXIS
Middle Name:RAFAEL
Last Name:PEREZ
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 W 84TH ST
Mailing Address - Street 2:SUITE# 3
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33014-3377
Mailing Address - Country:US
Mailing Address - Phone:305-825-6451
Mailing Address - Fax:
Practice Address - Street 1:1550 W 84TH ST
Practice Address - Street 2:SUITE# 3
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33014-3377
Practice Address - Country:US
Practice Address - Phone:305-557-8880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN152241223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice