Healthcare Provider Details

I. General information

NPI: 1710670005
Provider Name (Legal Business Name): MARIANA PERAZA D.M.D
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1815 S CLINTON AVE STE 510
ROCHESTER NY
14618-5721
US

IV. Provider business mailing address

7 ACADIA LN UNIT 6205
SHELTON CT
06484-4466
US

V. Phone/Fax

Practice location:
  • Phone: 585-685-2005
  • Fax:
Mailing address:
  • Phone: 813-503-4326
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number22DI03087300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: