Healthcare Provider Details

I. General information

NPI: 1689690273
Provider Name (Legal Business Name): HECTOR PEREZ-MARTI DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10769 NW 58TH ST
DORAL FL
33178-2801
US

IV. Provider business mailing address

10769 NW 58TH ST
DORAL FL
33178-2801
US

V. Phone/Fax

Practice location:
  • Phone: 305-471-7575
  • Fax: 305-471-7909
Mailing address:
  • Phone: 305-471-7575
  • Fax: 305-471-7909

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License NumberDN00114110
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: