Healthcare Provider Details

I. General information

NPI: 1326473810
Provider Name (Legal Business Name): ELISABETH L. EASLEY-PEREZ DMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2013
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11111 REINER RD
MONROE WA
98272-7846
US

IV. Provider business mailing address

11111 REINER RD
MONROE WA
98272-7846
US

V. Phone/Fax

Practice location:
  • Phone: 530-524-6020
  • Fax:
Mailing address:
  • Phone: 530-524-6020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number117
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: