Healthcare Provider Details

I. General information

NPI: 1932021235
Provider Name (Legal Business Name): EDDIE PEREZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2026
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 N LAKE DESTINY RD STE 130
MAITLAND FL
32751-7105
US

IV. Provider business mailing address

1101 N LAKE DESTINY RD STE 130
MAITLAND FL
32751-7105
US

V. Phone/Fax

Practice location:
  • Phone: 321-304-2912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number32203
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: