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General NPI Number Information
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NPI Number | 1114775731
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Entity Type | Individual
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Provider Name | AMANDA GRACE PEREZ DDS
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Gender | Female
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Dates
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Enumeration Date | 05/08/2024
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Last Update Date | 04/09/2025
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Provider Practice Location Address
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Address Line | 1645 E HIGHWAY 50 STE 100
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City | CLERMONT
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State | FL
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Zip | 34711-5199
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Country | US
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Telephone | 352-432-1960
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Fax |
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Provider Business Mailing Address
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Address Line | 18755 SW 212TH ST
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City | MIAMI
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State | FL
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Zip | 33187-4015
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Country | US
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Telephone | 786-314-8712
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 29159
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License Number State | FL
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