Healthcare Provider Details

I. General information

NPI: 1306291711
Provider Name (Legal Business Name): MELISSA SANTOS PEREZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2016
Last Update Date: 06/30/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1820 GADSDEN HWY STE 112
BIRMINGHAM AL
35235
US

IV. Provider business mailing address

1801 WINNSBORO RD
BIRMINGHAM AL
35213-1742
US

V. Phone/Fax

Practice location:
  • Phone: 205-490-8515
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number6369
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: