Healthcare Provider Details

I. General information

NPI: 1497088983
Provider Name (Legal Business Name): PEDRO JUAN PEREZ JR. DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 SUGGS ST
ROSSVILLE GA
30741-2223
US

IV. Provider business mailing address

1430 SUGGS ST
ROSSVILLE GA
30741-2223
US

V. Phone/Fax

Practice location:
  • Phone: 706-657-7575
  • Fax: 706-866-5512
Mailing address:
  • Phone: 706-657-7575
  • Fax: 706-866-5512

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License NumberDN013967
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License NumberDS038007
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: