Healthcare Provider Details

I. General information

NPI: 1740204023
Provider Name (Legal Business Name): LUIS AUGUSTO PEREZ D.D.S.,M.S.,P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 10/26/2022
Certification Date: 10/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 S LINDEN RD SUITE D
FLINT MI
48532-5475
US

IV. Provider business mailing address

2222 S LINDEN RD SUITE D
FLINT MI
48532-5475
US

V. Phone/Fax

Practice location:
  • Phone: 810-230-1311
  • Fax: 810-230-1314
Mailing address:
  • Phone: 810-230-1311
  • Fax: 810-230-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number2901017487
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: