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General NPI Number Information
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NPI Number | 1295419109
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Entity Type | Individual
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Provider Name | RAFAEL JOSE PEREZ GONZALEZ DMD
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Gender | Male
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 410 N JEFF DAVIS DR
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City | FAYETTEVILLE
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State | GA
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Zip | 30214-1630
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Country | US
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Telephone | 678-228-8348
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Fax |
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Provider Business Mailing Address
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Address Line | 50 SPRING BRANCH CT
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City | NEWNAN
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State | GA
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Zip | 30265-1833
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Country | US
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Telephone | 770-842-5250
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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 | DN123071
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License Number State | GA
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