MEDICARE: DR. NELSON A PEREZ DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	2277	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	041910	OTHER	PR	LA CRUZ AZUL
2	42292PE	OTHER	PR	TRIPLE S

General Provider Information

NPI Number	:	1043217516
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NELSON A PEREZ DMD

Provider Business Mailing Address
First Line	:	CALLE LAUREL 2306
Second Line	:	COND. THE TERRACE 10F
City	:	SAN JUAN
State	:	PR
Zip	:	00913
Country	:	US
Telephone Number	:	787-378-7275
Fax Number	:	787-657-2931

Provider Business Practice Location Address
First Line	:	CALLE 54 BG 176
Second Line	:	JARDINES DE RIO GRANDE
City	:	RIO GRANDE
State	:	PR
Zip	:	00745
Country	:	US
Telephone Number	:	787-887-7281
Fax Number	:	787-888-7008

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	09/15/2011

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