Healthcare Provider Details

I. General information

NPI: 1356300255
Provider Name (Legal Business Name): ROQUE A PEREZ DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 03/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BARCELO #40
UTUADO PR
00641
US

IV. Provider business mailing address

PO BOX 234
UTUADO PR
00641
US

V. Phone/Fax

Practice location:
  • Phone: 787-894-2516
  • Fax: 787-894-2516
Mailing address:
  • Phone: 787-894-2516
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number534
License Number StatePR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: