Healthcare Provider Details

I. General information

NPI: 1235204520
Provider Name (Legal Business Name): MIGUEL HUGO PEREZ DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: HUGO PEREZ DDS

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 W IRVING PARK RD
CHICAGO IL
60613-1920
US

IV. Provider business mailing address

5404 N HOYNE AVE
CHICAGO IL
60625-1112
US

V. Phone/Fax

Practice location:
  • Phone: 773-404-8030
  • Fax:
Mailing address:
  • Phone: 773-936-8030
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number01921518
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: