Provider Demographics
NPI:1841538303
Name:FRITZI A PEREZ-MYERS, DMD, INC.
Entity type:Organization
Organization Name:FRITZI A PEREZ-MYERS, DMD, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRITZI
Authorized Official - Middle Name:
Authorized Official - Last Name:PEREZ-MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:858-586-9195
Mailing Address - Street 1:PO BOX 262465
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92196-2465
Mailing Address - Country:US
Mailing Address - Phone:858-586-9195
Mailing Address - Fax:858-586-9198
Practice Address - Street 1:9750 MIRAMAR RD STE 160
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92126-4561
Practice Address - Country:US
Practice Address - Phone:858-586-9195
Practice Address - Fax:858-586-9198
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-17
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA39998122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB39998OtherMEDI-CAL