MEDICARE: DR. ALEXIS PEREZ JR. DDS

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	1223G0001X	General Practice Dentistry	DN29628	FL
2	1223G0001X	General Practice Dentistry	109173	CA
3	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1437932852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXIS PEREZ JR. DDS

Provider Business Mailing Address
First Line	:	624 E SAN SEBASTIAN CT
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32714-3014
Country	:	US
Telephone Number	:	321-316-8683
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 WEKIVA SPRINGS RD STE 100
Second Line	:
City	:	LONGWOOD
State	:	FL
Zip	:	32779-6050
Country	:	US
Telephone Number	:	407-961-7114
Fax Number	:

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

Provider Enumeration Date	:	08/17/2023
Last Update Date	:	08/29/2025

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