MEDICARE: YANELIS 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	390200000X	Student in an Organized Health Care Education/Training Program
2	1223G0001X	General Practice Dentistry	DN21219	FL

General Provider Information

NPI Number	:	1790179364
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	YANELIS PEREZ DMD

Provider Business Mailing Address
First Line	:	4047 OKEECHOBEE BLVD
Second Line	:	SUITE 219
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-3239
Country	:	US
Telephone Number	:	561-640-7600
Fax Number	:

Provider Business Practice Location Address
First Line	:	4047 OKEECHOBEE BLVD
Second Line	:	SUITE 219
City	:	WEST PALM BEACH
State	:	FL
Zip	:	33409-3239
Country	:	US
Telephone Number	:	561-640-7600
Fax Number	:

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

Provider Enumeration Date	:	03/22/2015
Last Update Date	:	06/28/2016

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