Provider Demographics
NPI:1952810392
Name:PEREZ, MONIKA ELISA (RDH, PHDHP)
Entity Type:Individual
Prefix:
First Name:MONIKA
Middle Name:ELISA
Last Name:PEREZ
Suffix:
Gender:F
Credentials:RDH, PHDHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9044 CONVENT AVE.
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19136-1122
Mailing Address - Country:US
Mailing Address - Phone:215-673-3610
Mailing Address - Fax:
Practice Address - Street 1:3156 KENSINGTON AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19134-2400
Practice Address - Country:US
Practice Address - Phone:215-302-3156
Practice Address - Fax:215-329-2000
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PADH009720L124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes124Q00000XDental ProvidersDental Hygienist