Healthcare Provider Details

I. General information

NPI: 1962536714
Provider Name (Legal Business Name): EDNA PEREZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 02/26/2020
Certification Date: 02/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER ROAD DEPARTMENT OF PEDIATRIC DENTISTRY COLLEGE OF DENTISTRY, UNIVERSITY OF FLORIDA
GAINESVILLE FL
32610-0426
US

IV. Provider business mailing address

PO BOX 100426 DEPARTMENT OF PEDIATRIC DENTISTRY COLLEGE OF DENTISTRY, UNIVERSITY OF FLORIDA
GAINESVILLE FL
32610-0426
US

V. Phone/Fax

Practice location:
  • Phone: 352-273-7631
  • Fax: 352-273-6765
Mailing address:
  • Phone: 352-273-7631
  • Fax: 352-273-6765

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0221X
TaxonomyPediatric Dentistry
License NumberDN18234
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: