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General NPI Number Information
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NPI Number | 1023972189
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Entity Type | Individual
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Provider Name | STACEY JANILL PEREZ
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Gender | Female
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Dates
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Enumeration Date | 12/12/2025
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Last Update Date | 12/12/2025
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Provider Practice Location Address
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Address Line | 93 WARD ST UNIT 513
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City | REVERE
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State | MA
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Zip | 02151-1346
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Country | US
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Telephone | 347-475-2869
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Fax |
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Provider Business Mailing Address
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Address Line | 93 WARD ST
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City | REVERE
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State | MA
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Zip | 02151-1335
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Country | US
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Telephone | 978-532-4903
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | DL101303
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License Number State | MA
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