Provider Demographics
NPI:1982761573
Name:PEREZ DENTAL CORP
Entity Type:Organization
Organization Name:PEREZ DENTAL CORP
Other - Org Name:PEREZ DENTAL CORP
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AZATUI
Authorized Official - Middle Name:
Authorized Official - Last Name:AKOPYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-246-3736
Mailing Address - Street 1:125 E GLENOAKS BLVD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91207
Mailing Address - Country:US
Mailing Address - Phone:818-246-3736
Mailing Address - Fax:818-246-9436
Practice Address - Street 1:125 E GLENOAKS BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91207
Practice Address - Country:US
Practice Address - Phone:818-246-3736
Practice Address - Fax:818-246-9436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
39063122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty